预后营养指数对肝泡型包虫病患者预后的预测价值

Abstract

目的 探讨预后营养指数(PNI)与肝泡型包虫病患者预后的关系。 方法 回顾性分析2015年1月—2018年12月青海大学附属医院肝胆胰外科收治的行肝泡型包虫病手术治疗的242例患者的临床资料。收集患者术前1周血常规及肝功能结果，计算PNI数值。通过X-Tile软件寻找PNI的临界值，并根据该临界值将患者分为高PNI组(n=216)和低PNI组(n=26)。计数资料两组两间比较采用χ²检验；Kaplan-Meier法绘制生存曲线，组间差异比较采用log-rank检验；采用Cox回归模型进行单因素和多因素分析，并计算风险比(HR)及对应的95%CI。 结果 PNI与治疗方式、术中出血量、包虫分期、病灶数、Child-Pugh分级、AST、TBil、Alb、ALP、PT、淋巴细胞计数均有关(P值均 < 0.05)。低PNI组与高PNI组患者术后1、3、5年生存率分别为92.1%、30.5%、20.3%和95.7%、79.5%、56.9%；低PNI组平均生存时间为33.783个月(95%CI：26.450~51.355)，高PNI组平均生存时间为51.355个月(95%CI：49.044~53.666)，两组比较差异有统计学意义(χ²=24.626，P < 0.001)。单因素Cox回归结果显示，PNI、手术方式、术中出血量、包虫分期、Child-Pugh分级、并发症、ALP、PT、中性粒细胞、血小板均与肝泡型包虫病患者预后有关(P值均 < 0.05)；多因素Cox回归结果显示，治疗方式(HR=1.461，95%CI：1.132~1.890，P＝0.004)、术中出血量(HR=6.078，95%CI：3.412~10.826，P < 0.001)、PNI(HR=0.367，95%CI：0.192~0.701，P=0.002)、并发症(HR=2.007，95%CI：1.204~3.346，P=0.008)、中性粒细胞(HR=2.772，95%CI：1.304~5.891，P=0.008)均是影响肝泡型包虫病患者预后的独立危险因素。 结论 PNI可以作为预测肝泡型包虫病患者术后的预后指标，术前外周血PNI越高，患者预后越好。

Alternate abstract:

Objective To investigate the value of prognostic nutritional index (PNI) in predicting the prognosis of patients with hepatic alveolar echinococcosis. Methods A retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgical treatment of hepatic alveolar echinococcosis. The results of routine blood test and liver function were collected at 1 week before surgery, and PNI was calculated. X-Tile software was used to determine the cut-off value of PNI, and according to this cut-off value, the patients were divided into high PNI group with 216 patients and low PNI group with 26 patients. The chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison between groups; the Cox regression model was used to perform univariate and multivariate analyses, and hazard ratio (HR) and corresponding 95% confidence interval (CI) were calculated. Results PNI was associated with treatment modality, intraoperative blood loss, stage of echinococcosis, number of lesions, Child-Pugh class, aspartate aminotransferase, total bilirubin, albumin, alkaline phosphatase (ALP), prothrombin time (PT), and lymphocyte count (all P < 0.05). The low PNI group had 1-, 3-, and 5-year survival rates of 92.1%, 30.5%, and 20.3%, respectively, after surgery, while the high PNI group had 1-, 3-, and 5-year survival rates of 95.7%, 79.5%, and 56.9%, respectively. The mean survival time was 33.783 (95% CI: 26.450-51.355) months in the low PNI group and 51.355 (95% CI: 49.044-53.666) months in the high PNI group, and there was a significant difference between the two groups (χ²=24.626, P < 0.001). The univariate Cox regression analysis showed that PNI, surgical procedure, intraoperative blood loss, stage of echinococcosis, Child-Pugh class, complication, ALP, PT, neutrophils, and platelets were associated with the prognosis of patients with hepatic alveolar echinococcosis (all P < 0.05), and the multivariate Cox regression analysis showed that treatment modality (HR=1.461, 95%CI: 1.132-1.890, P=0.004), intraoperative blood loss (HR=6.078, 95%CI: 3.412-10.826, P < 0.001), PNI(HR=0.367, 95%CI: 0.192-0.701, P=0.002), complications (HR=2.007, 95%CI: 1.204-3.346, P=0.008), and neutrophils (HR=2.772, 95%CI: 1.304-5.891, P=0.008) were independent risk factors for the prognosis of patients with hepatic alveolar echinococcosis. Conclusion PNI can be used to predict the prognosis of patients with hepatic alveolar echinococcosis. The higher the peripheral blood PNI before surgery, the better the prognosis of patients.