中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

第三腰椎骨骼肌指数联合白细胞介素6、激活素A对胰腺癌恶病质的早期预测价值

李新省 张丽敏 王顺祥 冯宁宁

引用本文:
Citation:

第三腰椎骨骼肌指数联合白细胞介素6、激活素A对胰腺癌恶病质的早期预测价值

DOI: 10.12449/JCH240624
基金项目: 

河北省医学科学研究课题计划 (20240222)

伦理学声明: 本研究方案于2020年1月19日经由河北医科大学第四医院伦理委员会审批,批号:2020KY085。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:李新省负责资料分析,撰写论文;张丽敏、王顺祥参与收集数据,修改论文;冯宁宁负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    冯宁宁, syanshuxuesan@163.com (ORCID: 0009-0002-8784-3918)

Value of skeletal muscle index combined with interleukin-6 and activin A in predicting early-stage pancreatic cancer cachexia

Research funding: 

Hebei Medical Science Research Project (20240222)

More Information
  • 摘要:   目的  研究第三腰椎骨骼肌指数(L3-SMI)联合白细胞介素6(IL-6)、激活素A(Activin A)检测对胰腺癌恶病质的早期预测价值。  方法  将2020年7月—2023年7月经河北医科大学第四医院确诊的74例胰腺癌患者纳入研究。根据患者入院后是否发生恶病质,分为恶病质组(n=58)、非恶病质组(n=16)。观测患者入院后48 h内的L3-SMI、IL-6、Activin A水平。正态分布的计量资料两组间比较采用成组t检验;计数资料组间比较采用χ2检验。采用多因素Logistic回归分析筛选胰腺癌恶病质的影响因素,并通过受试者工作特征曲线(ROC曲线)分析L3-SMI以及血清IL-6、Activin A单独或联合检测对胰腺癌恶病质的预测价值。ROC曲线下面积(AUC)比较采用Z检验。  结果  恶病质组L3-SMI水平明显高于非恶病质组,血清IL-6、Activin A水平明显低于非恶病质组(t值分别为8.649、3.049、8.100,P值均<0.05)。多因素Logistic回归分析结果显示,L3-SMI(OR=0.266,95%CI:0.103~0.683)以及血清IL-6(OR=4.158,95%CI:1.368~12.333)、Activin A(OR=5.124,95%CI:1.550~16.939)是胰腺癌恶病质发生的影响因素(P值均<0.05)。L3-SMI、IL-6、Activin A预测胰腺癌恶病质的AUC分别为0.851、0.752、0.791,均明显低于三者联合检测的0.946(Z值分别为-2.841、-2.552、-2.647,P值均<0.001),其敏感度、特异度、约登指数最高,分别为90.9%、87.8%、0.788。  结论  L3-SMI联合血清IL-6、Activin A检测对胰腺癌恶病质具有较好的早期预测价值。

     

  • 图  1  L3-SMI、IL-6、Activin A单独及联合检测预测胰腺癌恶病质的ROC曲线

    Figure  1.  ROC curve for L3-SMI, IL-6, and Activin A measured alone or in combination for perdiction of pancreatic cancer cachexia

    表  1  两组患者基线资料比较

    Table  1.   Cmparison of the baseline data between the two groups

    指标 恶病质组(n=58) 非恶病质组(n=16) χ2 P
    性别[例(%)] 0.416 0.519
    31(53.4) 10(62.5)
    27(46.6) 6(37.5)
    年龄[例(%)] 0.083 0.774
    ≥65岁 42(72.4) 11(68.7)
    <65岁 16(27.6) 5(31.3)
    肿瘤大小[例(%)] 0.019 0.984
    ≥3 cm 47(81.0) 13(81.2)
    <3 cm 11(19.0) 3(18.8)
    TNM分期[例(%)] 8.919 0.030
    Ⅰ期 0(0.0) 1(6.2)
    Ⅱ期 11(19.0) 6(37.5)
    Ⅲ期 20(34.5) 3(18.8)
    Ⅳ期 27(46.5) 6(37.5)
    肿瘤组织学分型[例(%)] 0.783 0.676
    低分化 8(13.8) 2(12.5)
    中分化 28(48.3) 6(37.5)
    高分化 22(37.9) 8(50.0)
    BMI分类[例(%)] 6.948 0.031
    正常体质量 30(51.7) 12(75.0)
    低体质量 24(41.4) 1(6.2)
    超重或肥胖 4(6.9) 3(18.8)
    NRS2002[例(%)] 7.485 0.006
    ≥3分 40(69.0) 5(31.2)
    <3分 18(31.0) 11(68.8)
    PG-SGA[例(%)] 14.233 <0.001
    ≥4分 44(75.9) 4(25.0)
    <4分 14(24.1) 12(75.0)
    注:正常体质量,18.5 kg/m2≤BMI<24.0 kg/m2;低体质量,BMI<18.5 kg/m2;超重或肥胖,BMI≥24 kg/m2
    下载: 导出CSV

    表  2  两组患者L3-SMI、IL-6、Activin A水平比较

    Table  2.   Cmparison of the level of L3-SMI,IL-6,Activin A between the two groups

    指标 恶病质组 (n=58) 非恶病质组 (n=16) t P
    L3-SMI(cm2/m2 28.44±4.32 39.45±5.16 8.649 <0.001
    IL-6(ng/L) 6.52±2.44 4.48±2.08 3.049 0.003
    Activin A(ng/L) 0.61±0.15 0.28±0.12 8.100 <0.001
    下载: 导出CSV

    表  3  胰腺癌恶病质发生的多因素Logistic回归分析

    Table  3.   Multivariate Logistic regression analysis of the occurrence of pancreatic cancer cachexia

    因素 β SE Wald P OR 95%CI
    常数项 -0.954 0.495 4.033 0.045 0.373 0.143~0.977
    L3-SMI -1.326 0.482 7.568 0.006 0.266 0.103~0.683
    IL-6 1.425 0.567 6.316 0.012 4.158 1.368~12.233
    Activin A 1.634 0.610 7.175 0.007 5.124 1.550~16.939
    下载: 导出CSV

    表  4  L3-SMI、IL-6、Activin A单独或联合检测对胰腺癌恶病质的预测价值

    Table  4.   Predictive value of L3-SMI, IL-6, and Activin A measured alone or in combination for pancreatic cancer cachexia

    因素 AUC 特异度(%) 敏感度(%) cut-off值 约登指数 95%CI
    L3-SMI 0.851 84.6 78.8 32.5 cm2/m2 0.634 0.750~0.953
    IL-6 0.752 52.6 82.6 5.2 ng/L 0.353 0.633~0.871
    Activin A 0.791 66.7 81.8 0.44 ng/L 0.485 0.674~0.909
    L3-SMI+IL-6+Activin A 0.946 87.8 90.9 0.788 0.890~1.000
    下载: 导出CSV
  • [1] ZHAN HX, LI YZ, HU SY. Tissue wasting and perioperative treatment strategies of pancreatic cancer patients[J]. Chin J Dig Surg, 2021, 20( 4): 407- 413. DOI: 10.3760/cma.j.cn115610-20210217-00079.

    展翰翔, 李永政, 胡三元. 胰腺癌病人组织消耗与围术期处理策略[J]. 中华消化外科杂志, 2021, 20( 4): 407- 413. DOI: 10.3760/cma.j.cn115610-20210217-00079.
    [2] ROBERTS DA, WATSON E, MACDONALD C, et al. Management of pain and Cachexia in pancreatic cancer: Protocol for two systematic reviews, network meta-analysis, surveys, and focus groups[J]. JMIR Res Protoc, 2023, 12: e46335. DOI: 10.2196/46335.
    [3] FAN M, GU XF, ZHANG WL, et al. Atractylenolide I ameliorates cancer cachexia through inhibiting biogenesis of IL-6 and tumour-derived extracellular vesicles[J]. J Cachexia Sarcopenia Muscle, 2022, 13( 6): 2724- 2739. DOI: 10.1002/jcsm.13079.
    [4] DAITOKU N, MIYAMOTO Y, HIYOSHI Y, et al. Activin A promotes cell proliferation, invasion and migration and predicts poor prognosis in patients with colorectal cancer[J]. Oncol Rep, 2022, 47( 6): 107. DOI: 10.3892/or.2022.8318.
    [5] Pancreatic Committee of Chinese Anti-Cancer Association. Comprehensive guidelines for the diagnosis and treatment of pancreatic cancer(2018 version)[J]. J Clin Hepatol, 2018, 34( 10): 2109- 2120. DOI: 10.3969/j.issn.1001-5256.2018.10.011.

    中国抗癌协会胰腺癌专业委员会. 胰腺癌综合诊治指南(2018版)[J]. 临床肝胆病杂志, 2018, 34( 10): 2109- 2120. DOI: 10.3969/j.issn.1001-5256.2018.10.011.
    [6] BABIC A, ROSENTHAL MH, SUNDARESAN TK, et al. Adipose tissue and skeletal muscle wasting precede clinical diagnosis of pancreatic cancer[J]. Nat Commun, 2023, 14( 1): 4317. DOI: 10.1038/s41467-023-40024-3.
    [7] SUN H, XU H, LU YY, et al. Clinical value of nutritional risk screening tools in identifying sarcopenia in patients with gastric cancer[J]. J Clin Med Pract, 2023, 27( 2): 78- 83. DOI: 10.7619/jcmp.20223111.

    孙慧, 徐慧, 陆滢滢, 等. 营养风险筛查工具识别胃癌患者肌减少症的临床价值[J]. 实用临床医药杂志, 2023, 27( 2): 78- 83. DOI: 10.7619/jcmp.20223111.
    [8] MARTIN A, FREYSSENET D. Phenotypic features of cancer cachexia-related loss of skeletal muscle mass and function: Lessons from human and animal studies[J]. J Cachexia Sarcopenia Muscle, 2021, 12( 2): 252- 273. DOI: 10.1002/jcsm.12678.
    [9] ZENG X, SHI ZW, YU JJ, et al. Sarcopenia as a prognostic predictor of liver cirrhosis: A multicentre study in China[J]. J Cachexia Sarcopenia Muscle, 2021, 12( 6): 1948- 1958. DOI: 10.1002/jcsm.12797.
    [10] WAKABAYASHI H, ARAI H, INUI A. The regulatory approval of anamorelin for treatment of cachexia in patients with non-small cell lung cancer, gastric cancer, pancreatic cancer, and colorectal cancer in Japan: Facts and numbers[J]. J Cachexia Sarcopenia Muscle, 2021, 12( 1): 14- 16. DOI: 10.1002/jcsm.12675.
    [11] YU ZL, SHANG NJ. Correlation between intramuscular fatty infiltration and sarcopenia after radical gastrectomy in elderly patients with gastric cancer[J]. J Mod Oncol, 2022, 30( 19): 3539- 3543. DOI: 10.3969/j.issn.1672-4992.2022.19.018.

    于子玲, 尚乃舰. 肌内脂肪浸润与老年胃癌根治术后肌少症的相关性[J]. 现代肿瘤医学, 2022, 30( 19): 3539- 3543. DOI: 10.3969/j.issn.1672-4992.2022.19.018.
    [12] ZHAO ZY, ZHANG YY, ZHAN XB. The value of skeletal muscle index of the third lumbar vertebra in nutritional risk assessment and prognosis of patients with advanced gastric cancer[J]. Mod Med J, 2022, 50( 11): 1371- 1376. DOI: 10.3969/j.issn.1671-7562.2022.11.003.

    赵志越, 张颖一, 湛先保. 第三腰椎骨骼肌指数在晚期胃癌患者营养风险评估及预后中的价值[J]. 现代医学, 2022, 50( 11): 1371- 1376. DOI: 10.3969/j.issn.1671-7562.2022.11.003.
    [13] POTOTSCHNIG I, FEILER U, DIWOKY C, et al. Interleukin-6 initiates muscle- and adipose tissue wasting in a novel C57BL/6 model of cancer-associated cachexia[J]. J Cachexia Sarcopenia Muscle, 2023, 14( 1): 93- 107. DOI: 10.1002/jcsm.13109.
    [14] QIU ZL, WO D, ZHONG XM, et al. Babao Dan alleviates cancer Cachexia in mice via inhibiting IL-6/STAT3 signaling pathway[J]. Integr Cancer Ther, 2023, 22: 15347354231168369. DOI: 10.1177/15347354231168369.
    [15] SHUKLA SK, MARKOV SD, ATTRI KS, et al. Macrophages potentiate STAT3 signaling in skeletal muscles and regulate pancreatic cancer cachexia[J]. Cancer Lett, 2020, 484: 29- 39. DOI: 10.1016/j.canlet.2020.04.017.
    [16] XU PC, YOU M, YU SY, et al. Visceral adipose tissue remodeling in pancreatic ductal adenocarcinoma cachexia: The role of activin A signaling[J]. Sci Rep, 2022, 12( 1): 1659. DOI: 10.1038/s41598-022-05660-7.
    [17] PINJUSIC K, AMBROSINI G, LOURENCO J, et al. Inhibition of anti-tumor immunity by melanoma cell-derived Activin-A depends on STING[J]. Front Immunol, 2024, 14: 1335207. DOI: 10.3389/fimmu.2023.1335207.
    [18] JIA SQ, ZHOU QY, LIU HM, et al. The mortality trend of digestive tract malignant tumor in China from 2004 to 2018[J]. Chin J Dis Contr Prev, 2021, 25( 9): 1020- 1025. DOI: 10.16462/j.cnki.zhjbkz.2021.09.006.

    贾善群, 周乾宇, 刘慧敏, 等. 2004―2018年中国消化道恶性肿瘤死亡趋势[J]. 中华疾病控制杂志, 2021, 25( 9): 1020- 1025. DOI: 10.16462/j.cnki.zhjbkz.2021.09.006.
    [19] CAI J, CHEN HD, LU M, et al. Trend analysis on morbidity and mortality of pancreatic cancer in China, 2005-2015[J]. Chin J Epidemiol, 2021, 42( 5): 794- 800. DOI: 10.3760/cma.j.cn112338-20201115-01328.

    蔡洁, 陈宏达, 卢明, 等. 2005—2015年中国胰腺癌发病与死亡趋势分析[J]. 中华流行病学杂志, 2021, 42( 5): 794- 800. DOI: 10.3760/cma.j.cn112338-20201115-01328.
    [20] WANG S, DU L, CHEN H, et al. Paracrine production of IL-6 promotes a hypercoagulable state in pancreatic cancer[J]. Am J Cancer Res, 2021, 11( 12): 5992- 6003.
  • 加载中
图(1) / 表(4)
计量
  • 文章访问数:  73
  • HTML全文浏览量:  44
  • PDF下载量:  14
  • 被引次数: 0
出版历程
  • 收稿日期:  2024-02-20
  • 录用日期:  2024-03-25
  • 出版日期:  2024-06-25
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回