目的 探讨基于主成分模型构建营养素综合指数对胃癌患者预后转归情况的预测效能。 方法 选取 2019 年 1 月至 2020 年 12 月于北京核工业医院接受根治术且术后随访至 2023 年 12 月的 210 例胃癌患者作为研究对象,根据术后随访 3 年 内有无出现复发或远处转移、死亡分为预后不良组(n = 57)和预后良好组( n = 153),对比两组基线资料,如性别、年龄、体质指 数(BMI)、吸烟史、饮酒史、高血压史、糖尿病史、肿瘤大小、临床分期、分化程度、术前淋巴结转移、脉管侵犯、营养素[铜(Cu)、 锌(Zn)、铁(Fe)、镁(Mg)、硒(Se)、Cu / Zn 比值];采用 Spearman 法分析元素与胃癌患者临床特征的相关性;采用 Pearson 法分 析营养素各指标之间的相关性;并采用主成分分析法构建营养素综合指数参数,通过绘制受试者操作特征曲线(ROC 曲线)分 析微量营养素综合指数预测胃癌患者预后转归的 AUC、敏感度及特异度。 结果 预后不良组的临床分期Ⅲ期占比、低分化占 比、术前淋巴结转移占比、脉管侵犯等基线资料占比,Cu 水平、Cu / Zn 均高于预后良好组,Zn、Mg、Se 水平均低于预后良好组 (P<0. 05);两组 Fe 水平比较,差异无统计学意义(P>0. 05)。 Spearman 相关性分析显示,临床分期、分化程度、术前淋巴结转 移、脉管侵犯与 Cu 水平、Cu / Zn 呈正相关,与 Zn、Mg、Se 水平呈负相关(P<0. 05)。 主成分分析结果显示,Zn、Mg、Se、Cu / Zn、Cu 权重系数均>0. 1,提示对胃癌患者预后转归具有较大影响。 ROC 曲线分析结果显示,Cu、Zn、Mg、Se、Cu / Zn 及营养素综合指数 预测胃癌患者预后转归情况的曲线下面积(AUC)值分别为 0. 637、0. 680、0. 739、0. 752、0. 769 及 0. 819。 结论 在胃癌预后不 良患者中,Cu、Zn、Mg、Se、Cu / Zn 等营养素呈异常表达趋势,说明其表达水平会受预后转归影响,动态监测营养素变化有利于 为评估胃癌患者预后提供参考依据。

Objective To explore the predictive efficacy of nutrient composite index based on principal component model for prognosis of patients with gastric cancer. Method A total of 210 patients with gastric cancer who were treated by Beijing Nuclear Industry Hospital from January 2019 to December 2020 and were followed up until December 2023 were selected as the study objects. The patients were divided into poor prognosis group n = 57 and good prognosis group n = 153 according to whether there was recurrence or distant metastasis or death within 3 years of postoperative follow-up. Baseline data gender age BMI smoking history drinking history hypertension history diabetes history tumor size clinical stage differentiation degree preoperative lymph node metastasis vascular invasion trace elements copper Cu zinc Zn iron Fe magnesium Mg selenium Se Cu / Zn ratio were compared between the two groups. Spearman method was used to analyze the correlation between trace elements and clinical characteristics of gastric cancer patients. Pearson method was used to analyze the correlation between the indexes of trace elements. The parameters of nutrient composite index were constructed by principal component analysis and the AUC sensitivity and specificity of nutrient composite index in predicting prognosis of patients with gastric cancer were analyzed by drawing receiver operating characteristic ROC curve. Result The proportion of clinical stage Ⅲ low differentiation preoperative lymph node metastasis,vascular invasion and other baseline data Cu and Cu / Zn in the poor prognosis group were higher than those in the good prognosis group while Zn Mg and Se were lower than those in the good prognosis group P < 0. 05 . There was no significant difference in Fe between the two groups P > 0. 05 . Spearman correlation analysis showed that clinical stage differentiation degree preoperative lymph node metastasis and vascular invasion were positively correlated with Cu and Cu / Zn and negatively correlated with Zn Mg and Se P < 0. 05 . The results of principal component analysis showed that the weight coefficients of Zn Mg Se Cu / Zn and Cu were all > 0. 1 suggesting that they had a great impact on the prognosis of patients with gastric cancer. ROC curve analysis results showed that the AUC values of Cu Zn Mg Se Cu / Zn and composite index in predicting the prognosis of gastric cancer patients were 0. 637 0. 680 0. 739 0. 752 0. 769 0. 819. Conclusion In patients with poor prognosis of gastric cancer the abnormal expression of Cu Zn Mg Se Cu / Zn and other nutrients indicates that their expression levels are affected by prognosis. Dynamic monitoring of micronutrient changes is conducive to providing a reference for evaluating the prognosis of patients with gastric cancer