胃癌患者术前血液中钾、钠、氯、镁、磷的相关性及其对生存预后的影响

Correlations among preoperative blood electrolytes and their influences on survival prognosis of gastric cancer patients

摘要:

目的  探讨胃癌（GC）患者术前血液电解质离子钾、钠、氯、镁、磷的相关性，以及与患者临床资料的相关性和对生存预后的影响。方法  收集该院320例大样本GC手术患者的临床资料，术前检测血液电解质水平，以及进行术后随访（最长随访时间为10年7个月）。统计学分析GC患者术前血液电解质水平的相关性、与侵袭转移的关系以及对患者生存预后的影响。结果  ①电解质离子与GC患者临床资料间的相关性：钾离子水平与癌细胞分化程度相关（P =0.022），氯离子水平与年龄相关（P =0.042）。②GC患者电解质离子水平之间存在相关性：如氯离子与钠离子相关（r =0.610，P =0.000），氯离子与钾离子相关（r =0.206，P =0.000），氯离子与镁离子相关（r =0.115，P =0.047）。③GC患者电解质水平对生存预后的影响：按正常范围分组，钾离子水平在3.5～5.3 mmol/L时患者生存预后最好，>5.3 mmol/L时预后最差（P =0.005）；按中位数分组，磷离子水平≥1.04 mmol/L组预后明显好于≤1.04 mmol/L组（P =0.008）。结论  钾离子水平与GC细胞分化程度相关，并影响患者生存预后。磷离子水平高低也影响患者生存预后。结合临床和影像诊断，GC患者术前检测血液电解质水平作为潜在的预警信号，可以对生存预后进行评估，将有助于制定最佳手术方案、术后放射和化学药物治疗策略，从而尽可能地提高治疗质量及延长生存时间。

Abstract:

Objective To investigate the correlations among preoperative electrolytes K+, Na+, Cl-, Mg2+, P2+, their relationships with clinical data, and their effects on survival prognosis in patients with gastric cancer (GC). Methods The complete clinical and follow-up (up to 127 months) information of 320 GC patients were collected from our Department of Pathology registered from January 2004 to June 2013. Blood electrolytes were tested before surgery and statistically analyzed. Results There were correlations between electrolytes and clinical data in the GC patients. The level of K+ was correlated with cell differentiation (P = 0.022). The level of Cl- in the GC patients was correlated with age (P = 0.042). There were correlations between Cl- and Na+ (r = 0.610, P = 0.000), Cl- and K+ (r = 0.206, P = 0.000), Cl- and Mg2+ (r = 0.115, P = 0.047). Patients' survival prognosis was impacted by K+ based on reference range grouping and the patients with 3.5-5.3 mmol/L K+ had the best prognosis (P = 0.005). The patients with P2+ ≥1.04 mmol/L had better prognosis than those with P2+ ≤1.04 mmol/L (P = 0.008) based on median grouping. Conclusions Blood level of K+ is correlated with cell differentiation and can influence the survival prognosis of GC patients. The level of P2+ also has an impact on the survival prognosis of GC patients. We propose that, combined with clinical and imaging diagnoses, utilizing electrolyte levels to preoperatively assess survival prognosis may help to select the best personalized strategies for surgery, chemotherapy, radiotherapy and follow-up intervals. These personalized strategies may help to achieve quality treatments, therefore improve quality of life and prolong survival of GC patients.