25-羟维生素D与儿童肾母细胞瘤的相关性及对疾病预后的评估价值分析

Correlation between 25-hydroxyvitamin D and nephroblastoma in children and its value in assessing disease prognosis

摘要:

目的 探讨25-羟维生素D［25-hydroxyvitamin D，25-(OH)D］与儿童肾母细胞瘤的相关性及对疾病预后的评估价值。方法 选取2018年1月—2022年12月收治的肾母细胞瘤患儿50例为肾母细胞瘤组，根据患儿术后病理类型，分为预后良好亚组（38例）和预后不良亚组（12例）。纳入同期体检的健康儿童50例为健康对照组。分析比较各组的血肌酐、25-(OH)D等水平。采用Spearman秩相关分析探讨25-(OH)D与儿童肾母细胞瘤治疗疗效反应的相关性，采用多因素logistic回归分析探讨影响儿童肾母细胞瘤预后的危险因素。结果 肾母细胞瘤组血肌酐、25-(OH)D水平低于健康对照组（P<0.05）。预后不良亚组肿瘤直径、肿瘤分期为Ⅲ~Ⅳ比例、转移比例高于预后良好亚组，血肌酐、25-(OH)D水平低于预后良好亚组（P<0.05）。Spearman秩相关分析显示，血清25-(OH)D水平与儿童肾母细胞瘤治疗疗效反应呈负相关（r_s=-0.685，P<0.001）。多因素logistic回归分析显示，肿瘤直径≥10 cm、肿瘤分期为Ⅲ~Ⅳ、存在转移及25-(OH)D<19 ng/mL与儿童肾母细胞瘤预后不良密切相关（P<0.05）。血清25-(OH)D水平评估儿童肾母细胞瘤预后的曲线下面积为0.805（95%CI：0.706~0.903，P<0.001），约登指数为0.512，最佳截断值为1.764 ng/mL，灵敏度、特异度分别为0.938、0.575。结论 25-(OH)D水平与儿童肾母细胞瘤预后存在显著相关性，可以通过判断25-(OH)D判断预后。

Abstract:

Objective To study the correlation between 25-hydroxyvitamin D [25-(OH)D] and nephroblastoma in children and its value in assessing the prognosis of the disease.Methods A total of 50 children with nephroblastoma who were admitted from January 2018 to December 2022 were included as the nephroblastoma group, and according to the postoperative pathological type, they were divided into a good prognosis group with 38 children and a poor prognosis group with 12 children. A total of 50 healthy children who underwent physical examination during the same period of time served as the healthy control group. The above groups were compared in terms of serum creatinine and 25-(OH)D level. A Spearman correlation analysis was used to investigate the correlation between serum 25-(OH)D level and therapeutic effect reaction. A multivariate logistic regression analysis was used to identify the risk factors affecting the prognosis of nephroblastoma in children.Results The nephroblastoma group had significantly lower levels of serum creatinine and 25-(OH)D than the healthy control group (P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly larger tumor diameter, a significantly higher proportion of children with stage III-IV tumors, a significantly higher rate of tumor metastasis, and significantly lower serum levels of creatinine and 25-(OH)D (P<0.05). The Spearman correlation analysis showed that serum 25-(OH)D level was negatively correlated with therapeutic effect reaction (r_s=-0.685, P<0.001). The multivariate logistic regression analysis showed that tumor diameter ≥10 cm, stage III-IV tumors, presence of tumor metastasis, and 25-(OH)D <19 ng/mL were closely associated with the poor prognosis of nephroblastoma in children (P<0.05). Serum 25-(OH)D level had an area under the curve of 0.805 (95%CI: 0.706-0.903, P<0.001) in evaluating the prognosis of nephroblastoma in children, with a Youden index of 0.512, a sensitivity of 0.938, and a specificity of 0.575 at the optimal cut-off value of 1.764 ng/mL.Conclusions There is a significant correlation between 25-(OH)D level and the prognosis of nephroblastoma in children, and 25-(OH)D can be used for prognosis prediction.