COUNT评分对于特发性肺纤维化病人肺移植早期预后的预测价值  

The predictive value of controlling the nutritional status score for the early prognosis of lung transplantation in patients with idiopathic pulmonary fibrosis

作　　者：刘敏 李小婉 王逸峰 孙玥 田静 董妍 王宋 许红阳 LIU Min;LI Xiao-wan;WANG Yi-feng;SUN Yue;TIAN Jing;DONG Yan;WANG Song;XU Hong-yang(Department of Critical Care Medicine,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi People's Hospital,214023,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡人民医院重症医学科,江苏无锡214023

出　　处：《肠外与肠内营养》2024年第3期135-142,共8页Parenteral & Enteral Nutrition

基　　金：无锡市太湖人才计划(2021THRC-TD-ZZYXK-2021)。

摘　　要：目的:研究控制营养状态(COUNT)评分对于特发性肺纤维化(IPF)病人肺移植早期预后的预测价值。方法:回顾性收集在无锡市人民医院行肺移植术的154名IPF病人,收集术前资料包括人口统计学资料、术前合并症以及最后一次的实验室检查结果,术中以及术后并发症情况。使用ROC曲线评估COUNT评分及其他营养评估工具预测30 d生存情况的能力,使用Kaplan-Meier法绘制低COUNT组和高COUNT组生存曲线,Log-rank比较两组生存率差异。并使用COX回归分析IPF病人术后30d预后不良的独立危险因素。结果:根据COUNT评分划分,IPF病人术前合并营养不良的有101例(65.6%)。COUNT评分对于IPF肺移植病人早期30d预后不佳的预测能力要高于BMI、Alb、PNI指数。使用ROC确定的cutoff值为2.5划分高低COUNT组,高COUNT组30d、90d生存率低于低COUNT组(P<0.05)。并且高COUNT组入ICU前24hAPACHEⅡ评分更高,术后AKI发生率更高,术后机械通气时间延长、ECMO转流时间延长(P<0.05)。多因素COX回归分析提示高COUNT评分及肥胖是IPF病人肺移植术后30d预后不佳的独立危险因素。结论:COUNT评分是肺移植早期预后不佳的预测因素,在IPF病人肺移植术前进行营养评估至关重要。Objective:To investigate the predictive value of the controlling nutritional status(COUNT)score for the early prognosis of lung transplantation in patients with idiopathic pulmonary fibrosis(IPF).Methods:Retrospective collection of 154 patients with IPF who underwent lung transplantation at Wuxi People's Hospital,preoperative data including demographics,preoperative comorbidities,and last laboratory findings,intraoperative as well as postoperative complications were collected.The ability of COUNT score and other nutritional assessment tools to predict 30-day survival was assessed using ROC curves,survival curves for the low and high COUNT score groups were plotted using the Kaplan-Meier method,and log-rank compared the difference in survival between the two groups.COX regression was also used to analyze independent risk factors for poor 30-day postoperative prognosis in IPF patients.Results:According to the division of COUNT score,there were 101 cases(65.6%)of preoperative combined malnutrition in IPF patients.COUNT score was more predictive of poor early 30-day prognosis in IPF lung transplant patients than BMI,Alb,and PNI indices.Using a cutoff value of 2.5 determined by ROC to divide the high group and low COUNT group,the 30-d and 90-d survival rates of the high COUNT group were lower than those of the low COUNT group(P<0.05).And the high COUNT group had a higher APACHE II score 24h before ICU admission,a higher incidence of postoperative AKI,a longer duration of postoperative mechanical ventilation,and a longer duration of ECMO diversion(P<0.05).The multivariate COX regression analysis suggested that low COUNT score and obesity were independent risk factors for poor prognosis in IPF patients 30 days after lung transplantation.Conclusion:COUNT score is a predictor of poor prognosis in early lung transplantation,and nutritional assessment is essential before lung transplantation in patients with IPF.

关 键 词：控制营养状态评分 肺移植 特发性肺纤维化 危险因素 

分 类 号：R459.3[医药卫生—治疗学] R563.1[医药卫生—临床医学]