γ-谷氨酰转移酶与白蛋白比值对经皮经肝胆道引流治疗恶性梗阻性黄疸的生存预测价值  

Value of γ-glutamyl transferase to albumin ratio in predicting survival of percutaneous transhepatic bile duct drainage for malignant obstructive jaundice:a single-center experience

作　　者：杨柳青 梁君蓉 赖俊浩 樊小伟 严红卫 YANG Liuqing;LIANG Junrong;LAI Junhao;FAN Xiaowei;YAN Hongwei(Department of General Surgery,PLA 987 Hospital,Joint Logistic Support Force,Baoji Shaanxi 721004,China)

机构地区：[1]联勤保障部队第987医院普通外科,陕西宝鸡721004 [2]联勤保障部队第987医院消化内科,陕西宝鸡721004

出　　处：《中国急救复苏与灾害医学杂志》2024年第9期1183-1187,1210,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：陕西省重点研发计划项目(编号:2017ZDXM-SF-25-5)。

摘　　要：目的分析γ-谷氨酰转移酶与白蛋白比值(GAR)与经皮经肝胆道引流术(PTBD)治疗恶性梗阻性黄疸患者生存预后的关系。方法对2019年1月—2022年3月联勤保障部队第987医院因恶性梗阻性黄疸接受姑息性PTBD治疗的104例患者进行回顾性分析。所有患者均有随访记录,主要终点是总生存期(OS)。结果死亡患者年龄较大,PTBD术后7 d内总胆红素水平较高,术前血小板计数绝对计数和GAR比值更高,而术前ALB水平和预后营养指数(PNI)较低,且接受进一步治疗的患者比例更低(P<0.05)。经受试者工作特征曲线分析,GAR结合PNI预测总生存率的曲线下面积(AUC)为0.898(95%CI:0.834~0.952,P<0.001),灵敏度和特异度为90.9%和70.8%,显著优于PNI单独预测的AUC值。术前PNI<39.57和GAR≥1.045是经PTBD治疗的恶性梗阴性黄疸患者在预后的预测因子(P<0.05)。Kaplan-Meier曲线和对秩数分析结果显示,GAR≥1.045的患者OS相较于GAR<1.045的患者更短(log-rank=28.292,P<0.001),且PNI<39.57的患者OS相较于PNI≥39.57的患者更短(log-rank=15.389,P<0.001)。在PNI≥39.57的患者中,GAR≥1.045患者OS相较于GAR<1.045患者也更短(log-rank=10.614,P=0.001)。结论术前GAR可作为接受姑息性PTBD治疗的恶性梗阻性黄疸患者生存预后的有力预测指标,且可补充PNI额外的预后信息。Objective To analyze the relationship between γ-glutamyl transferase to albumin ratio(GAR)and survival prognosis in patients with malignant obstructive jaundice treated by percutaneous transhepatic bile duct drainage(PTBD).Methods A retrospective survival analysis of 104 patients who received palliative PTBD for malignant obstructive jaundice between January 2019 and March 2022 was performed.All patients were followed up and the primary endpoint was overall survival(OS).Results The patients who died were older,had higher total bilirubin level within 7 days after PTBD,higher platelet count absolute count and GAR ratio before surgery,lower ALB level and PNI before surgery,and a lower proportion of patients receiving further therapy(P<0.05).According to receiver operating characteristic curve analysis,the area under curve(AUC)of GAR combined with prognostic nutritional index(PNI)was 0.898(95%CI:0.834-0.952,P<0.001),and the sensitivity and specificity were 90.9% and 70.8%,which were significantly better than those predicted by PIN alone.Preoperative PNI<39.57 and GAR≥1.045 were statistically significant independent predictors of overall survival rate(P<0.05).Kaplan-Meier curve and rank analysis showed that patients with GAR≥1.045 had shorter OS than those with GAR<1.045(log-rank=28.292,P<0.001).Similarly,patients with PNI<39.57 had shorter OS than those with PNI≥39.57(log-rank=15.389,P<0.001).In addition,in patients with PNI≥39.57,patients with GAR≥1.045 had a shorter OS than patients with GAR<1.045(log-rank=10.614,P=0.001).Conclusion Preoperative GAR can be used as predictors of survival in patients with malignant obstructive jaundice treated with palliative PTBD,which can supplement the additional prognostic information of PNI.

关 键 词：Γ谷氨酰转移酶 白蛋白 经皮经肝胆道引流 恶性梗阻性黄疸 总生存期 

分 类 号：R575[医药卫生—消化系统]