预后营养指数对老年病人肝癌切除术后腹腔感染预测价值研究
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摘要
目的探讨预后营养指数(PNI)对老年肝癌切除术后病人发生腹腔感染的预测价值。方法回顾性分析西安交通大学第一附属医院收治的270例行手术切除治疗老年原发性肝癌病例资料。采用受试者工作曲线(ROC)、多因素分析及生存曲线确定术前PNI对术后腹腔感染的预测价值。结果共筛选出34例腹腔感染病人,累积发生率为12.59%(34/270)。术前PNI预测术后并发腹腔感染的最佳截断值为47.58(P<0.05)。合并糖尿病、贫血及PNI<47.58是肝癌切除术后并发腹腔感染的独立危险因素(P<0.05)。PNI<47.58的腹腔感染病人术后近期总体存活率和无复发存活率均较低,但差异无统计学意义(P>0.05)。结论术前PNI对老年肝癌切除术后病人并发腹腔感染具有一定的预测价值。
Objective To investigate the predictive significance of prognostic nutritional index(PNI)for intraabdominal infections(IAIs)in gerontal liver cancer patients who received hepatectomy.Methods The clinical data of270 gerontal(age≥60 y)patients with primary liver cancer(PLC)who received hepatectomy in the First Affiliated Hospital of Xi' an Jiaotong University were retrospectively analyzed.Receiver operating characteristic curve(ROC),multivariate analysis and survival curve were used to conduct the predictive significance of preoperative PNI for IAIs.Results The incidence of IAIs was 12.59%(34/270)in this cohort.The cut-off value of preoperative PNI for the prediction of postoperative IAIs was 47.58(P<0.05).Patients with diabetes mellitus,anemia and PNI<47.58 were demonstrated as the independent risk factors for postoperative IAIs(P<0.05,respectively).Patients with PNI<47.58 suffered lower but not significantly short-term over-all and disease-free survival rate(P>0.05).Conclusion Preoperative PNI determination has predictive value for postoperative IAIs in gerontal liver cancer patients who received hepatectomy.
Objective To investigate the predictive significance of prognostic nutritional index(PNI)for intraabdominal infections(IAIs)in gerontal liver cancer patients who received hepatectomy.Methods The clinical data of270 gerontal(age≥60 y)patients with primary liver cancer(PLC)who received hepatectomy in the First Affiliated Hospital of Xi' an Jiaotong University were retrospectively analyzed.Receiver operating characteristic curve(ROC),multivariate analysis and survival curve were used to conduct the predictive significance of preoperative PNI for IAIs.Results The incidence of IAIs was 12.59%(34/270)in this cohort.The cut-off value of preoperative PNI for the prediction of postoperative IAIs was 47.58(P<0.05).Patients with diabetes mellitus,anemia and PNI<47.58 were demonstrated as the independent risk factors for postoperative IAIs(P<0.05,respectively).Patients with PNI<47.58 suffered lower but not significantly short-term over-all and disease-free survival rate(P>0.05).Conclusion Preoperative PNI determination has predictive value for postoperative IAIs in gerontal liver cancer patients who received hepatectomy.
引文
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[11]任华建,胡琼源,王革非,等.预后营养指数对肠瘘患者术后手术部位感染的预测价值[J].中华普通外科杂志,2018,33(4):284-287.
[12]Shirata C,Hasegawa K,Kokudo T,et al.Surgical site infection after hepatectomy for hepatocellular carcinoma[J].Dig Surg,2018,35(3):204-211.
[13]Durczynski A,Strzelczyk J,Wojciechowska-Durczynska K,et al.Major liver resection results in early exacerbation of insulin resistance,and may be a risk factor of developing overt diabetes in the future[J].Surg Today,2013,43(5):534-538.
[14]王新颖.免疫营养制剂临床应用争议与共识[J].中国实用外科杂志,2018,38(3):261-266
[15]DedinskáI,Laca L,Miklu?ica J,et al.Complications of liver resection in geriatric patients[J].Ann Hepatol,2017,16(1):149-156.(2019-04-22收稿2019-05-06修回)
[2]Clemente G,De Rose AM,Murri R,et al.Liver resection for primary intrahepatic stones:focus on postoperative infectious complications[J].World J Surg,2016,40(2):433-439.
[3]Siniorakis EE,Tsarouhas K,Tsitsimpikou C,et al.Neutrophil to lymphocyte(N/L)and platelet to lymphocyte(P/L)ratios in differentiating acute heart failure from respiratory infection[J].Curr Vasc Pharmacol,2017,15(5):477-481.
[4]Biyikli E,Kayipmaz AE,Kavalci C,et al.Effect of platelet-lymphocyte ratio and lactate levels obtained on mortality with sepsis and septic shock[J].Am J Emerg Med,2018,36(4):647-650.
[5]Hu Q,Wang G,Ren J,et al.Preoperative prognostic nutritional index predicts postoperative surgical site infections in gastrointestinal fistula patients undergoing bowel resections[J].Medicine(Baltimore),2016,95(27):e4084.
[6]刘允怡,赖俊雄.肝癌肝切除手术方式的理论基础及临床价值[J].中国实用外科杂志,2018,38(4):345-348.
[7]Reccia I,Kumar J,Kusano T,et al.A systematic review on radiofrequency assisted laparoscopic liver resection:Challenges and window to excel[J].Surg Oncol,2017,26(3):296-304.
[8]宋晨鑫,丛明华,邹宝华,等.肝癌肝部分切除术后并发感染危险因素分析[J].实用癌症杂志,2018,33(10):1593-1596.
[9]刘娟,刘艳萍.肝癌患者术后并发肺部感染的危险因素[J].医疗装备,2018,31(20):142-143.
[10]Maruyama Y,Inoue K,Mori K,et al.Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as predictors of wound healing failure in head and neck reconstruction[J].Acta Otolaryngol,2017,137(1):106-110.
[11]任华建,胡琼源,王革非,等.预后营养指数对肠瘘患者术后手术部位感染的预测价值[J].中华普通外科杂志,2018,33(4):284-287.
[12]Shirata C,Hasegawa K,Kokudo T,et al.Surgical site infection after hepatectomy for hepatocellular carcinoma[J].Dig Surg,2018,35(3):204-211.
[13]Durczynski A,Strzelczyk J,Wojciechowska-Durczynska K,et al.Major liver resection results in early exacerbation of insulin resistance,and may be a risk factor of developing overt diabetes in the future[J].Surg Today,2013,43(5):534-538.
[14]王新颖.免疫营养制剂临床应用争议与共识[J].中国实用外科杂志,2018,38(3):261-266
[15]DedinskáI,Laca L,Miklu?ica J,et al.Complications of liver resection in geriatric patients[J].Ann Hepatol,2017,16(1):149-156.(2019-04-22收稿2019-05-06修回)