术前乳酸脱氢酶水平在胶质瘤患者预后预测中的应用价值
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张建鹤,男,主治医师,医学博士

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Retrospective Study of Predictive Value of Preoperative Serum LactateDehydrogenase Level in Prognosis of Glioma
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    摘要:

    目的研究术前血清乳酸脱氢酶(LDH)对胶质瘤进展以及患者预后的预测价值。 方法 收集2014年1月-2017年1月行手术治疗的胶质瘤患者92例,分析患者的临床资料、实验室指标、影像学资料及随访生存情况。根据无进展生存时间(PFS)将患者分为长PFS组(≥1 a)和短PFS组(<1 a)。采用单因素和多因素logistic回归分析与PFS≥1 a的相关因素;采用受试者工作曲线(ROC)评估LDH的最佳分界值;采用Kaplan-Meier生存分析曲线和Cox比例风险评估模型研究患者随访3 a时的生存情况。 结果 单因素和多因素回归分析发现,术前LDH(OR=0.96,95%CI:0.93~0.98, P =0.001)是PFS≥1 a的独立相关因素。ROC曲线分析发现,术前LDH预测胶质瘤患者PFS≥1 a的曲线下面积为0.768(95%CI:0.669~0.850),最佳界值为185.5 U/L,敏感性为75%,特异性为62.5%。Kaplan-Meier曲线分析发现,术前LDH有无异常升高与患者术后3 a生存率明显相关( P <0.001)。多因素的Cox分析发现,LDH是否>250 U/L是患者术后3 a生存率的独立相关因素(HR=0.29,95% CI:0.15~0.57, P <0.001)。 结论 术前血清LDH可作为预测胶质瘤患者预后的可靠指标,但需要多中心、大样本量的研究进一步证实。

    Abstract:

    Objective To investigate the predictive value of preoperative serum lactate dehydrogenase (LDH) in predicting glioma progression and patients’ prognosis. Methods A total of 92 patients admitted in our institution for glioma resection from January 2014 to January 2017 was included in this retrospectively study. Clinical data, laboratory indexes and imaging features were collected for all patients.The patients were grouped based on 1 year of the progress free survival (PFS). Univariate and multivariate logistic regression analysis were separately used to evaluate the independent factor related with progress free survival. The receiver operating characteristic curve (ROC) was used to determine the optimal cutoff value of LDH. The Kaplan-Meier and Cox regression analysis were used to determine the independent prognostic factors with patients’ survival at 3 years follow-up. Results Univariate and multivariate logistic regression analysis showed that preoperative serum LDH(OR=0.96, 95% CI: 0.93-0.98, P =0.001)was correlated with patients’ progress free survival. The ROC showed that the optimal cutoff value, sensitivity, specificity and under the curve of LDH in predicting PFS were 185.5 U/L, 75%, 62.5% and 0.768 (95% CI: 0.669-0.850). The Kaplan-Meier curve showed that the mortality at 3 years follow-up of abnormal elevated LDH group was significantly higher than that of normal LDH group(P<0.001). The multivariate Cox analysis showed that whether LDH is in normal level(HR=0.29, 95% CI: 0.15-0.57, P <0.001)was independent factor related with patients’ survival at 3 years follow-up. Conclusion Preoperative serum LDH level is indicated as a reliable factor for predicting glioma patients’ outcome. However, multi-center and large-scale study is needed to validate the results.

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张建鹤,方圆,陈仲辉,王磊,宋建华,陈宇.术前乳酸脱氢酶水平在胶质瘤患者预后预测中的应用价值[J].福建医科大学学报自然版,2021,55(6):13-17

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  • 在线发布日期: 2022-02-17
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