术前预后营养指数与原发性肝癌患者的临床病理特征及预后的相关性研究  

Correlation between preoperative prognostic nutritional index and clinicopathological features and prognosis of patients with primary liver cancer

作　　者：朱永乐 彭阳阳 王帝 赵萍 闪海霞[3] Zhu Yongle;Peng Yangyang;Wang Di;Zhao Ping;Shan Haixia(Department of Nutrition,Nanyang Central Hospital,Nanyang,Henan 473005,China;Department of General Surgery,Nanyang Central Hospital,Nanyang,Henan 473005,China;Department of Infectious Diseases,Nanyang Central Hospital,Nanyang,Henan 473005,China)

机构地区：[1]南阳市中心医院营养科,河南南阳473005 [2]南阳市中心医院普外科,河南南阳473005 [3]南阳市中心医院感染科,河南南阳473005

出　　处：《齐齐哈尔医学院学报》2025年第6期550-554,共5页Journal of Qiqihar Medical University

基　　金：河南省医学科技攻关计划项目(LHGJ20200905)。

摘　　要：目的探讨原发性肝癌患者术前预后营养指数(PNI)与患者预后的相关性。方法纳入2020年1月—2021年12月本院收治的180例原发性肝癌患者(原发性肝癌组)和同期50名健康体检者(对照组)作为研究对象。收集临床病理数据及术前PNI数值。对原发性肝癌患者术后进行随访并分为预后良好组(n=91)和预后不良组(n=89)两个亚组。根据89例预后不良的原发性肝癌患者外周血中位PNI表达水平,分为PNI高表达组(n=45,PNI≥43.55)和PNI低表达组(n=44,PNI<43.55)。Logistic回归分析原发性肝癌患者发生预后不良的独立危险因素,PNI与原发性肝癌患者发生预后不良中位时间的关系采用K-M曲线分析。结果对照组和原发性肝癌组外周血中PNI水平分别为(47.34±3.34)和(41.09±2.78),与对照组相比,原发性肝癌组PNI水平明显降低,差异有统计学意义(P<0.05)。性别、平均年龄、吸烟饮酒史、原发病、肝硬化病史、肿瘤大小、肿瘤部位、肿瘤类型、AFP水平在预后良好组和预后不良组中相比无明显差异(P>0.05)。与预后良好组相比,肿瘤细胞分化程度为低分化比例、发生血管侵犯比例、CNLC分期为Ⅱ~Ⅲa期比例在预后不良组中显著升高,而白蛋白及PNI水平明显降低,差异均具有统计学意义(P<0.05)。Logistic回归分析结果显示,发生血管侵犯(OR=4.445)、CNLC分期为Ⅱ~Ⅲa期(OR=3.218)是原发性肝癌患者术后发生预后不良的独立危险因素,而PNI水平升高(OR=0.673)是原发性肝癌患者术后发生预后不良的保护因素。ROC曲线结果显示,术前PNI在预测原发性肝癌患者术后发生预后不良的AUC为0.956,当PNI截断值为44.16,诊断敏感性和特异度分别为95.44%和90.28%。PNI高表达组和低表达组发生预后不良的中位时间分别为18个月和11个月,与PNI高表达组相比,PNI低表达组出现预后不良的中位时间明显缩短(P<0.05)。结论术前PNI可作为原发性肝癌患者发生预后不Objective To investigate the correlation between preoperative prognostic nutritional index(PNI)and prognosis in patients with primary liver cancer.Methods A total of 180 patients with primary liver cancer(primary liver cancer group)admitted to our hospital between January 2020 and December 2021,and 50 healthy controls(control group)were included in the study.Clinicopathological data and preoperative PNI values were collected.The primary liver cancer patients were followed up and divided into two subgroups:good prognosis group(n=91)and poor prognosis group(n=89).Based on the median PNI level in peripheral blood of the 89 patients with poor prognosis,they were further divided into PNI high-expression group(n=45,PNI≥43.55)and PNI low-expression group(n=44,PNI<43.55).Logistic regression analysis was used to identify independent risk factors for poor prognosis in primary liver cancer patients.The relationship between PNI and the median time to poor prognosis was analyzed using the Kaplan-Meier(K-M)method.Results The peripheral blood PNI levels in the control group and the primary liver cancer group were(47.34±3.34)and(41.09±2.78),respectively.Compared with the control group,the PNI levels in the primary liver cancer group were significantly decreased,and the difference was statistically significant(P<0.05).There were no significant differences in gender,mean age,smoking and drinking history,primary disease,cirrhosis history,tumor size,tumor site,tumor cell type,and AFP level between the good prognosis group and the poor prognosis group(P>0.05).Compared with the good prognosis group,the proportion of tumor cell differentiation with low differentiation,the proportion of vascular invasion and the proportion of CNLC stage withⅡtoⅢa stage were significantly increased in the poor prognosis group,while the levels of albumin and PNI were significantly decreased,with statistical significance(P<0.05).The Logistic regression analysis showed that vascular invasion(OR=4.445)and CNLC stage withⅡ-Ⅲa stage(OR=3.218)were i

关 键 词：原发性肝癌 预后 预后营养指数 CNLC分期 

分 类 号：R735.7[医药卫生—肿瘤]