老年营养风险指数预测胰十二指肠切除术后并发症发生的价值  

Value of geriatric nutritional risk index in predicting postoperative complications after pancreaticoduodenectomy in the elderly

作　　者：张博林 阿提古·阿布都外力 苏洪德 耿诚 徐新建 ZHANG Bolin;ATIGU·Abuduwaili;SU Hongde;GENG Cheng;XU Xinjian(Department of Hepatobiliary and Pancreatic Surgery,The Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,P.R.China)

机构地区：[1]新疆医科大学第五附属医院肝胆胰腺外科,乌鲁木齐830011

出　　处：《中国普外基础与临床杂志》2025年第2期199-204,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：新疆维吾尔自治区自然科学基金-面上项目(项目编号:2021D01C424)。

摘　　要：目的评价老年营养风险指数(geriatric nutritional risk index,GNRI)对行胰十二指肠切除术(pancreaticoduodenectomy,PD)的老年胰腺癌患者术后并发症及严重并发症发生的预测价值。方法回顾性分析2017年1月至2021年10月期间在新疆医科大学第五附属医院收住入院并行PD的老年(≥65岁)胰腺癌患者的临床资料,汇总其总并发症及严重并发症(Clavien-Dindo分级Ⅲ~Ⅴ级定义为严重并发症)发生情况;采用单因素和多因素logistic回归模型分析GNRI是否是PD术后总并发症及严重并发症的危险因素,同时采用受试者操作特征曲线下面积评估GNRI区分PD术后总并发症和严重并发症发生的能力,同时确认其最佳临界值并据此将患者分为高营养风险组(大于最佳临界值)和低营养风险组(小于及等于最佳临界值),比较二者的临床结局。结果本研究共纳入行PD的老年胰腺癌患者190例,有95例(50.0%)发生并发症,其中严重并发症28例(29.5%)。多因素logistic回归分析结果显示,GNRI降低是影响老年胰腺癌患者PD后总并发症和严重并发症发生的危险因素[分别:OR(95%CI)=0.361(0.154,0.848),P=0.019;OR(95%CI)=0.906(0.834,0.983),P=0.018];GNRI评估PD后总并发症和严重并发症发生的受试者操作特征曲线下面积分别为0.765和0.715,其最佳临界值分别为98和96,与低营养风险组比较,高营养风险组术后总住院费用、总并发症和严重并发症发生率均更高(分别:Z=–2.37、P=0.019;χ^(2)=44.61、P<0.001;χ^(2)=29.39、P<0.001)。结论从本研究结果看,老年胰腺癌患者接受PD后严重并发症的发生率并不低。GNRI对PD后总体和严重并发症发生具有良好的区分价值。对术前GNRI<98或GNRI<96时应及时给予患者早期术前营养支持治疗。Objective To evaluate the predictive value of the geriatric nutritional risk index(GNRI)for postoperative overall and severe complications after pancreaticoduodenectomy(PD)in the elderly patients with pancreatic cancer.Methods The clinical data of the elderly(65 years old or more)patients with pancreatic cancer underwent PD were retrospectively collected,who were admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from January 2017 to October 2021.The incidences of postoperative overall and severe complications(Clavien-Dindo gradeⅢ–Ⅴwas defined as severe complications)were summarized.The univariate and multivariate logistic regression models were used to analyze whether GNRI was a risk factor for overall and severe complications after PD.The area under the receiver operating characteristic curve(AUC)was used to evaluate the ability of GNRI to distinguish whether overall or severe complications occurred after PD and to confirm the optimal threshold.Then the patients were assigned into a high nutritional risk group(greater than the optimal threshold)and low nutritional risk group(the optimal threshold or less)based on this.Simultaneously,the clinical outcomes of the two groups were compared.Results In this study,190 elderly patients with pancreatic cancer were enrolled,95(50.0%)of whom developed complications,including 28(29.5%)cases of serious complications.The results of multivariate logistic regression model analysis showed that the decreased GNRI was a risk factor for the occurrence of overall and severe complications after PD for the elderly patients[OR(95%CI)=0.361(0.154,0.848),P=0.019;OR(95%CI)=0.906(0.834,0.983),P=0.018].The AUC of GNRI for assessing the occurrence of overall and severe complications was 0.765 and 0.715,respectively,with the optimal critical values of 98 and 96,respectively.Compared with the low nutritional risk group,the high nutritional risk group had higher postoperative total hospitalization costs(Z=–2.37,P=0.019),higher occurrences of overall complications(

关 键 词：老年营养风险指数 胰腺癌 胰十二指肠切除术 总并发症 严重并发症 

分 类 号：R73[医药卫生—肿瘤]