预后营养指数对肝泡型包虫病患者预后的预测价值

陈小彬; 袁加琪; 许召君; 樊海宁; 侯立朝; 王海久; 周瀛; 陈鹏杰; 王志鑫

doi:10.3969/j.issn.1001-5256.2021.05.033

预后营养指数对肝泡型包虫病患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.05.033

陈小彬^1a,
袁加琪^1a,
许召君^1b,
樊海宁^{1a, 2},
侯立朝^{1a, 2},
王海久^{1a, 2},
周瀛^{1a, 2},
陈鹏杰^1a,
王志鑫^{1a, 2, ,}

1a.
青海大学附属医院肝胆胰外科，西宁810001
1b.
青海大学附属医院胃肠外科，西宁810001
2.
青海省包虫病重点实验室，西宁 810001

基金项目:

青海省人畜包虫病防控策略与创新技术应用 (2016-SF-A5);

青海大学中青年科研基金项目 (2016-QYY-4)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：陈小彬负责课题设计、资料分析及撰写论文；袁加琪、许召君参与收集数据及修改论文；王志鑫、侯立朝、樊海宁、王海久、周瀛、陈鹏杰负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
陈小彬(1992—)，男，主要从事肝包虫病、普通外科临床研究

袁加琪(1993—)，男，主要从事肝包虫病、普通外科临床研究

许召君(1995—)，女，主要从事普通外科、胃肠方向临床研究

通信作者:
王志鑫，zhixin_wang001@sina.com

三者对本文贡献相同，同为第一作者

中图分类号: R532.32
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出版历程
- 收稿日期: 2020-10-25
- 录用日期: 2020-12-10
- 出版日期: 2021-05-20

Value of prognostic nutritional index in predicting the prognosis of patients with hepatic alveolar echinococcosis

Xiaobin CHEN^1a,
Jiqi YUAN^1a,
Zhaojun XU^1b,
Haining FAN^{1a, 2},
Lizhao HOU^{1a, 2},
Haijiu WANG^{1a, 2},
Ying ZHOU^{1a, 2},
Pengjie CHEN^1a,
Zhixin WANG^{1a, 2
, ,}

1a.
Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining 810001, China
1b.
Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining 810001, China
2.
Qinghai Province Key Laboratory of Hydatid Disease Research, Xining 810001, China

摘要

摘要: 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。
- 棘球蚴病, 肝 /
- 预后营养指数 /
- 预后
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.
- Echinococcosis, Hepatic /
- Prognostic Nutritional Index /
- Prognosis

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图 1 PNI的X-Tile结果

注：a，二维生存风险伪彩图；b，频数分布直方图; c, 分段后生存曲线。

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图 2 两组肝泡型包虫病患者术后总体生存曲线

下载: 全尺寸图片幻灯片

表 1 PNI与肝泡型包虫病患者临床病理因素的关系

因素	高PNI组(n=216)	低PNI组(n=26)	χ²值	P值	因素	高PNI组(n=216)	低PNI组(n=26)	χ²值	P值
年龄[例(%)]			2.004	0.157	AST[例(%)]			3.948	0.047
≤30岁	71(32.9)	5(19.2)			≤40 U/L	111(51.4)	8(30.8)
>30岁	145(67.1)	21(80.8)			>40 U/L	105(48.6)	18(69.2)
性别[例(%)]			1.366	0.242	TBil[例(%)]			9.249	0.002
男	82(38.1)	13(50.0)			≤34.2 μmol/L	126(58.3)	7(26.9)
女	133(61.9)	13(50.0)			>34.2 μmol/L	90(41.7)	19(73.1)
治疗方式[例(%)]			42.049	< 0.001	>34.2 μmol/L	90(41.7)	19(73.1)
根治性治疗	180(83.3)	7(26.9)			Alb[例(%)]			15.487	< 0.001
姑息治疗	36(16.7)	19(73.1)			≤35 g/L	132(61.1)	26(100.0)
术中出血量[例(%)]			12.114	< 0.001	>35 g/L	84(38.9)	0
< 1000 ml	135(62.5)	7(26.7)			ALP[例(%)]			8.367	0.004
≥1000 ml	81(37.5)	19(73.3)			≤150 U/L	54(25.0)	0
包虫分期¹⁾[例(%)]			18.529	< 0.001	>150 U/L	162(75.0)	26(100.0)
早、中期	113(52.3)	2(7.7)			PT[例(%)]			8.324	0.004
晚期	103(47.7)	24(92.3)			≤16 s	106(49.1)	5(19.2)
有无转移[例(%)]			1.593	0.207	≤16 s	106(49.1)	5(19.2)
有	168(77.8)	23(88.5)			>16 s	110(50.9)	21(80.8)
无	48(22.2)	3(11.5)			中性粒细胞[例(%)]			0.536	0.464
病灶数[例(%)]			5.729	0.017	≤6.3×10⁹/L	199(92.6)	23(88.5)
单发	135(62.8)	10(38.5)			>6.3×10⁹/L	16(7.4)	3(11.5)
多发	80(32.7)	16(61.5)			血小板[例(%)]			2.968	0.085
Child-Pugh分级[例(%)]			18.199	< 0.001	≤300×10⁹/L	111(51.4)	18(69.2)
A级	103(47.7)	1(3.8)			>300×10⁹/L	105(48.6)	8(30.8)
B级	113(52.3)	25(96.2)			>300×10⁹/L	105(48.6)	8(30.8)
并发症[例(%)]			2.534	0.111	淋巴细胞[例(%)]			8.509	0.004
有	114(52.8)	18(69.2)			≤0.8×10⁹/L	10(4.6)	5(19.2)
无	102(47.2)	8(30.8)			>0.8×10⁹/L	206(95.4)	21(80.8)
ALT[例(%)]			0.001	0.975	白细胞[例(%)]			1.364	0.243
≤40 U/L	99(45.8)	12(46.2)			≤10×10⁹/L	185(85.6)	20(76.9)
>40 U/L	117(54.2)	14(53.8)			>10×10⁹/L	31(14.4)	6(23.1)
注：1)根据影像学检查，肝泡型包虫病在肝内侵袭范围以及临床表现，将肝泡型包虫病分为早、中、晚3期。早期病灶局限于1个肝段，中期病灶侵犯≥2个肝段，晚期合并多种并发症或脏器转移。

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表 2 影响肝泡型包虫患者生存的单因素及多因素分析

因素	单因素分析		多因素分析
因素	HR(95%CI)	P值	HR(95%CI)	P值
年龄(≤30岁=1; >30岁=2)	1.272(0.744~2.175)	>0.05
性别(男=1;女=2)	1.268(0.791~2.033)	>0.05
治疗方式(根治手术=1; 姑息治疗=2)	3.195(1.973~5.176)	< 0.001	1.461(1.132~1.890)	0.004
术中出血量(< 1000 ml=1; ≥1000 ml=2)	6.832(3.893~11.990)	< 0.001	6.078(3.412~10.826)	< 0.001
包虫分期(早期=0; 中、晚期=2)	3.841(2.017~7.318)	< 0.05
转移(有=0; 无=1)	1.430(0.731~2.797)	>0.05
病灶数(< 单发=1;多发=2)	1.104(0.688~1.773)	>0.05
PNI(≤32.4=1; >32.4=2)	0.254(0.141~0.457)	< 0.001	0.367(0.192~0.701)	0.002
Child~Pugh分级(A级=1;B级=2)	3.066(2.716~6.449)	< 0.05
并发症(无=0; 有=1)	2.278(1.398~3.711)	< 0.05	2.007(1.204~3.346)	0.008
ALT(≤40 U/L=1; >40 U/L=2)	1.201(0.748~1.931)	>0.05
AST(≤40 U/L=1; >40 U/L=2)	1.436(0.894~2.307)	>0.05
TBil(≤32.4 μmol/L=1; >32.4 μmol/L=2)	1.572(0.983~2.514)	>0.05
ALP(≤150 U/L=1; >150 U/L=2)	2.237(1.180~4.790)	< 0.05
PT(≤16=1; >16=2)	1.824(1.113~2.991)	< 0.05
中性粒细胞(≤7×10⁹/L =1; >7×10⁹/L=2)	2.533(1.210~5.304)	< 0.05	2.772(1.304~5.891)	0.008
血小板(≤300×10⁹/L=1; >300×10⁹/L=2)	2.016(1.248~3.257)	< 0.05	1.609(0.969~2.672)	0.066
白细胞(≤10×10⁹/L=1; >10×10⁹/L=2)	1.486(0.797~2.770)	>0.05

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