超声造影定量参数结合CEA、CA19-9水平预测结直肠癌术后ARF风险的列线图模型的构建与验证
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安徽省卫生健康科研项目(AHWJ2023BAa20176);


Development and validation of a risk nomogram model for the prediction of ARF following colorectal cancer surgery using quantitative parameters from contrast-enhanced ultrasound in combination with CEA and CA19-9 levels
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    摘要:

    目的:构建与验证列线图风险预测模型,探讨超声造影定量参数结合癌胚抗原(CEA)、糖链抗原(CA19-9)对结直肠癌术后急性肾功能衰竭(ARF)的预测价值。方法:选取102例行结直肠癌根治术的患者为研究对象,将术后发生ARF患者设为研究组(n=50);术后未发生ARF患者设为对照组(n=52)。两组患者均行超声造影、血常规等检查。比较两组患者超声造影定量参数、CEA、CA19-9水平等一般资料;单因素及多因素Logistic回归分析结直肠癌术后发生ARF的危险因素,据此建立列线图风险预测模型,并进行验证。结果:单因素分析及Logistic回归分析结果显示,高峰值强度(PI)、曲线下面积(AUC)、平均渡越时间(MTT)水平、达峰时间(TTP)延迟、肾小球滤过率(eGFR)水平及血清CEA、CA19-9高表达是影响结直肠癌患者术后发生ARF的危险因素(P<0.05),且据此建立的列线图风险预测模型显示,PI、TTP、MTT、AUC异常是结直肠癌患者术后发生ARF的最强预测因子,其次血清CEA、CA19-9呈高表达;采用计算机模拟重采样(Bootstrap法)对列线图模型进行内部验证,结果显示,列线图模型预测结直肠癌患者术后发生ARF的AUC为0.870,敏感度为80.26%,特异度为86.70%;C-index为0.816,H-L拟合优度检验结果显示,预测值与实际观测值比较,差异无统计学意义(χ2=4.116,P=0.468)。结论:超声造影定量参数异常及血清CEA、CA19-9高表达均是影响结直肠癌患者术后发生ARF的危险因素,据此构建的列线图模型能有效预测结直肠癌术后ARF的发生风险。

    Abstract:

    Objective:To develop and validate a risk nomogram model that investigates the predictive value of quantitative pa-rameters from contrast-enhanced ultrasound in combination with carcinoembryonic antigen(CEA)and carbohydrate antigen(CA19-9)for postoperative acute renal failure(ARF)following colorectal cancer surgery.Methods:A total of 50 patients with postoperative ARF(study group)and 52 patients without postoperative ARF(control group)who underwent radical resection of colorectal cancer were en-rolled.All patients underwent contrast-enhanced ultrasound examination,blood routine examination,etc.Quantitative parameters of con-trast-enhanced ultrasound,CEA and CA19-9 levels were collected.Univariate and multivariate Logistic regression analyses were per-formed to identify the risk factors associated with ARF following colorectal cancer surgery,and a nomogram risk prediction model was developed and validated.Results:The results of univariate analysis and Logistic regression analysis demonstrated that elevated levels of peak intensity(PI),area under the curve(AUC),mean transit time(MTT),time to Peak(TTP)delay,glomerular filtration rate(eG-FR),as well as high expression of serum CEA and CA19-9,were identified as significant risk factors for postoperative ARF in patients with colorectal cancer(P<0.05).The nomogram revealed that abnormal values of PI,TTP,MTT,and AUC were the most robust pre-dictors for postoperative ARF in patients with colorectal cancer,followed by high expression of serum CEA and CA19-9.Internal valida-tion using computer simulation resampling through the Bootstrap method was employed to validate the nomogram model.The verification results indicated an area under the ROC curve of 0.870 for the nomogram,with a sensitivity of 80.26% and specificity of 86.70%.The C-index was calculated as 0.816,while the H-L goodness-of-fit test showed no significant difference between predicted values and actu-al observations(x2=4.116,P=0.468).Conclusion:Abnormal quantitative parameters of contrast-enhanced ultrasound and high ex-pression of serum CEA and CA19-9 are risk factors for postoperative ARF in patients with colorectal cancer.The nomogram model,con-structed based on these factors,demonstrates effective predictive capability for assessing the risk of postoperative ARF in patients with colorectal cancer.

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王琮;王逸群;杨燕;段秉慧;.超声造影定量参数结合CEA、CA19-9水平预测结直肠癌术后ARF风险的列线图模型的构建与验证[J].川北医学院学报,2025,40(7):855-860.

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  • 在线发布日期: 2025-08-10
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