预后营养指数与非心脏手术后心肌损伤的关系  

Relationship between prognostic nutritional index and myocardial injury after non-cardiac surgery

作　　者：李昭 李皓[1] 刘畅 姚四一 娄景盛[1] 刘艳红[1] 曹江北[1] 米卫东[1] Li Zhao;Li Hao;Liu Chang;Yao Siyi;Lou Jingsheng;Liu Yanhong;Cao Jiangbei;Mi Weidong(Department of Anesthesiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Graduate School of Chinese PLA General Medical School,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心麻醉科,北京100853 [2]解放军医学院研究生院,北京100853

出　　处：《中华麻醉学杂志》2024年第11期1317-1322,共6页Chinese Journal of Anesthesiology

摘　　要：目的评价预后营养指数(PNI)与非心脏手术后心肌损伤(MINS)的关系。方法本研究为回顾性队列研究。收集2016年1月至2019年8月于本中心行全身麻醉下肝脏切除术的成年患者(n=2203)的临床资料。采用受试者工作特征曲线评价术前PNI对MINS的预测价值并确定其最佳截断值,以此为依据将患者分为高PNI组和低PNI组。采用logistic回归分析术前PNI与MINS的关系。依据相同纳排标准收集本中心2022年1月至2023年12月患者(n=2525)的临床资料作为验证集,根据同一PNI截断值分组,采用logistic回归验证PNI与MINS的关系。结果受试者工作特征曲线分析显示术前PNI预测MINS的曲线下面积为0.651(95%CI 0.602~0.699),最佳截断值46.193,特异度和灵敏度分别为0.729和0.519。取PNI最佳截断值整数46,将患者分为低PNI组(PNI<46,n=606)和高PNI组(PNI≥46,n=1597)。单因素和多因素logistic回归分析显示,术前低PNI是MINS发生的独立危险因素(单因素:OR=2.873,95%CI 2.063~4.003,P<0.001;多因素:OR=1.844,95%CI 1.241~2.600,P=0.003)。验证集中结果依然稳健(单因素:OR=2.694,95%CI 1.890~3.833,P<0.001;多因素:OR=1.602,95%CI 1.071~2.385,P=0.021)。结论术前低水平PNI是MINS的独立危险因素,对MINS有一定预测价值。Objective To evaluate the relationship between prognostic nutritional index(PNI)and myocardial injury after non-cardiac surgery(MINS).Methods This was a retrospective cohort study.The clinical data of adult patients(n=2203)who underwent liver resection surgery with general anesthesia at our center from January 2016 to August 2019 were retrospectively collected.The predictive value of preoperative PNI for MINS and the optimal cut-off value of PNI were evaluated and determined according to the receiver operating characteristic curve,and the patients were divided into 2 groups based on the cut-off value:high PNI group and low PNI group.Logistic regression analyses were applied to investigate the relationship between preoperative PNI and MINS.According to the same inclusion and exclusion criteria,the clinical data of patients at our center from January 2022 to December 2023 were collected as the validation set(n=2525),and they were grouped using the same PNI cutoff value.Logistic regression analyses were used to verify the relationship between PNI and MINS.Results The receiver operating characteristic curve analysis showed that the area under the curve of preoperative PNI for predicting MINS was 0.651(95% confidence interval[CI]0.602-0.699),with an optimal cut-off value of 46.193,and the specificity and sensitivity were 0.729 and 0.519 respectively.The integer 46 was considered as the optimal cutoff value for PNI,and the patients were divided into low PNI group(PNI<46,n=606)and high PNI group(PNI≥46,n=1597).Both univariate and multivariate logistic regression analyses showed that preoperative low PNI was an independent risk factor for the occurrence of MINS(univariate:OR=2.873,95%CI 2.063-4.003,P<0.001;multivariate:OR=1.844,95%CI 1.241-2.600,P=0.003).The results in the validation set were still robust(univariate:OR=2.694,95%CI 1.890-3.833,P<0.001;multivariate:OR=1.602,95%CI 1.071-2.385,P=0.021).Conclusions Preoperative low-level PNI is an independent risk factor for MINS,with a certain predictive value.

关 键 词：营养评价 手术后并发症 心肌损伤 非心脏手术 

分 类 号：R614[医药卫生—麻醉学]