不同TNM分期老年胃癌患者临床特征及术后并发肠漏的影响因素分析.pdf

临床和实验医学杂志2 0 2 3年8 月第2 2 卷第15期J.Eur Rev Med Pharmacol Sci,2018,22(24):8675-8681.4Dekker E,Tanis PJ,Vleugels JLA,et al.Colorectal cancer J.Lan-cet,2019,394(10207):1467-1480.5Lu TX,Rothenberg ME.MicroRNAJ.J Allergy Clin Immunol,2018,141(4):1202-1207.6 Wang JK,Wang Z,Li G.MicroRNA-125 in immunity and cancerJ.Cancer Lett,2019,454:134-145.7Luo S,Wang J,Ma Y,et al.PPARgamma inhibits ovarian cancer cellsproliferation through upregulation of miR-125b J.Biochem BiophysRes Commun,2015,462(2):85-90.8Bernstein DL,Gajghate S,Reichenbach NL,et al.let-7g counteractsendothelial dysfunction and ameliorating neurological functions in mouseischemia/reperfusion stroke modelJ.Brain Behav Immun,2020,87:543-555.9 Lopez-Aguilar JE,Velazquez-Flores MA,Simon-Martinez LA,etal.Circulating microRNAs as Biomarkers for Pediatric AstrocytomasJ.Arch Med Res,2017,48(4):323-332.10 Keller DS,Berho M,Perez RO,et al.The multidisciplinary manage-ment of rectal cancerJ.Nat Rev Gastroenterol Hepatol,2020,17(7):414 429.11 Moridikia A,Mirzaei H,Sahebkar A,et al.MicroRNAs:Potential can-1605didates for diagnosis and treatment of colorectal cancer J.J Cell Phys-iol,2018,233(2):901-913.12 Ha Thi HT,Kim HY,Kim YM,et al.MicroRNA-130a modulates aradiosensitivity of rectal cancer by targeting SOX4 J.Neoplasia,2019,21(9):882-892.13 Ma X,Li C,Sun L,et al.Lin28/let-7 axis regulates aerobic glycoly-sis and cancer progression via PDK1 J.Nat Commun,2014,5:5212.14 Luan W,Wang Y,Chen X,et al.PKM2 promotes glucose metabolismand cell growth in gliomas through a mechanism involving a let-7a/c-Myc/hnRNPA1 feedback loopJ.Oncotarget,2015,6(15):13006-13018.15 Yao A,Xiang Y,Si Y R,et al.PKM2 promotes glucose metabolismthrough a let-7a-5p/Stat3/hnRNP-A1 regulatory feedback loop inbreast cancer cellsJ.J Cell Biochem,2019,120(4):6542-6554.16 Duan S,Yu S,Yuan T,et al.Exogenous Let-7a-5p Induces A549Lung Cancer Cell Death Through BCL2L1-Mediated PI3Kgamma Sig-naling PathwayJ.Front Oncol,2019,9:808.（收稿日期:2 0 2 3-0 2-15D0I:10.3969/j.issn.1671-4695.2023.15.010不同TNM分期老年胃癌患者临床特征及术后并发肠漏的影响因素分析李赞赵黎*梁海滨（上海交通大学医学院附属新华医院普外科上海2 0 0 0 92）【摘要】目的分析不同TNM分期老年胃癌患者临床特征及术后并发肠漏的影响因素。方法回顾性分析2 0 19年3月至2 0 2 2 年3月上海交通大学医学院附属新华医院收治的2 0 0 例老年胃癌患者的临床资料，根据TNM分期将其分为I/I组（n=68）、/V 组（n=132）,比较两组临床特征性别、年龄、分化程度、浸润深度、有无转移、癌胚抗原（CEA）、糖类抗原199（CA199）磷酸化蛋白激酶B(PKB/AKT）、脾酪氨酸蛋白激酶（Syk）蛋白表达情况】。另根据术后是否并发肠漏将其分为并发组（n=114）、非并发组（n=86）。对两组一般资料（包括性别、年龄、肿瘤直径、TNM分期、手术方式、是否合并脏器切除、术中出血量、术前血红蛋白、白蛋白进行比较,将其中有明显差异的变量纳入多因素Logistic回归分析,筛选出影响老年胃癌患者术后并发肠漏的独立危险因素。结果/I V组低分化程度、黏膜层以下、淋巴结转移、远处转移、PKB/AKT阳性表达占比及CEA、CA 199水平分别为55.30%、6 6.6 7%、7 4.2 4%、43.18%、7 9.55%、(22.411.36）n g/m L、(37.551.8 9）U/m L,均高于I/I组14.7 1%、6.6 2%、17.6 5%、2.9 4%、57.35%、（7.150.62）n g/m L、（2 0.0 51.2 7）U/m L,Sy k 阳性表达占比为12.8 8%，低于I/I组（39.7 1%），差异均有统计学意义（P0.05）。经Pearson检验发现，TNM分期与浸润深度、有淋巴结转移、有远处转移、CEA高表达、CA199高表达、PKB/AKT阳性表达均呈正相关（r=0.8170.820、0.8 14、0.8 55、0.8 2 6.0.8 34，P 0.0 5），与分化程度、Syk阳性表达均呈负相关（r=-0.802、-0.8 11，P 0.0 5）。并发组肿瘤直径为（5.48 1.45)cm，长于非并发组（3.140.8 3)cm,胸腹联合手术、合并脏器切除占比及术中出血量分别为35.0 9%、2 9.8 2%、（331.7 0 2 7.46)mL，均高于非并发组4.6 5%、16.28%、（2 0 4.6 514.2 0)m L)，术前血红蛋白、术前白蛋白水平分别为（115.12 10.8 5）、（34.57 4.8 9）g/L，均低于非并发组（134.3111.8 7）、（42.50 5.8 5）g/L，差异均有统计学意义（P0.05）。多因素Logistic回归分析结果显示,肿瘤直径4cm以上、胸腹联合手术、合并脏器切除、术中出血量2 7 0 mL以上、术前血红蛋白12 5g/L以下、术前白蛋白38.5g/L以下均为老年胃癌患者术后并发肠漏的独立危险因素（0 R=4.536、5.0 7 3、4.47 3、4.7 7 3、4.18 7、4.90 9，P0.05）。结论不同TNM分期老年胃癌患者的临床特征存在一定差异,TNM分期与分化程度、浸润深度、有无转移、肿瘤标志物水平、基因蛋白表达相关；肿瘤直径、手术方式、合并脏器切除、术中出血量、术前营养指标均为老年胃癌患者术后并发肠漏的危险因素，临床应采取相应措施予以改善。【关键词】TNM分期胃癌临床特征肠漏影响因素基金项目：国家自然科学基金资助项目（编号：8 2 17 30 8 1）*通讯作者：赵黎,E-mail:文章编号：16 7 1-46 9 5(2 0 2 3)15-16 0 5-0 4:1606:Clinical characteristics of elderly patients with gastric cancer at different TNM stages and analysis of influencing factors of postoperativeintestinal leakage.LI Yun,ZHAO Li,LIANG Hai-bin.Department of General Surgery,Xinhua Hospital Afiliated to Shanghai Jiaotong Universi-ty School of Medicine,Shanghai 200092,China.Abstract Objective To analyze the clinical characteristics of elderly gastric cancer patients with different TNM stages and the influen-cing factors of postoperative intestinal leakage.MethodsThe clinical data of 200 elderly patients with gastric cancer admitted to Xinhua HospitalAffiliated to Shanghai Jiaotong University School of Medicine from March 2019 to March 2022 were retrospectively analyzed.They were divided intogroup IVII(n=68)and group II/IV(n=132)according to TNM stage,and the clinical characteristics of the two groups sex,age,degree ofdifferentiation,depth of invasion,metastasis,carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),phosphorylated protein ki-nase B(PKB/AKT),spleen tyrosine protein kinase(Syk)protein expression of the two groups were comparedJ were compared.In addition,thepatients were divided into concurrent group(n=114)and non-concurrent group(n=86)according to whether postoperative intestinal leakageoccurred.The general data of the two groups were compared,and the variables with significant differences were included in the multivariate logis-tic regre