预后营养指数和营养风险筛查对弥漫性大B细胞淋巴瘤患者预后的影响

Prognostic value of prognostic nutritional index and nutritional risk screening in patients with diffuse large B cell lymphoma

目的探讨预后营养指数(prognostic nutritional index,PNI)和营养风险筛查评分与弥漫性大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)患者近期疗效及预后的影响。方法回顾性分析2012年7月~2019年7月徐州医科大学附属医院收治的145例初治DLBCL患者的临床资料,统计患者PNI值和营养风险筛查NRS-2002评分。评价患者近期疗效。绘制生存曲线,并对相关的单因素及多因素进行分析。结果采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)计算Youden指数,PNI最佳截断值为44.65,将患者分为低PNI组(<44.65)和高PNI组(≥44.65)。根据营养风险筛查NRS-2002评估表,3分作为分界值,将患者分为营养良好组(<3分)和营养较差组(≥3)。患者化疗后进行疗效评价,高PNI组客观缓解率(objective response rate,ORR)高于低PNI组,差异具有统计学意义(χ^(2)=9.928,P=0.002)。营养良好组ORR高于营养较差组,且差异具有统计学意义(χ^(2)=12.675,P=0.0001)。高PNI组总生存时间(overall survival,OS)高于低PNI组,营养良好组OS高于营养较差组。高PNI且营养良好组OS平均66个月,生存时间明显长于其他组合,预后最好。低PNI且营养较差组OS平均28个月,生存时间明显低于其他组合,预后最差。单因素及多因素结果显示,PNI(P<0.001)、营养风险筛查评分(P<0.001)、年龄(P=0.027)、淋巴细胞计数(P=0.002)、白蛋白(P<0.001)是影响患者OS预后的独立危险因素。结论PNI值联合营养状况评分可作为DLBCL患者临床预后指标。

Objective To investigate the clinical significance of prognostic nutritional index(PNI)and nutritional risk screening in patients with diffuse large B cell lymphoma(DLBCL).Methods The clinical data from 145 patients with DLBCL who were newly diagnosed in Affiliated Hospital of Xuzhou Medical University from July 2012 to July 2019 were retrospectively analyzed,a nd the PNI value and the NRS-2002 score of nutritional risk screening were analyzed.The short-term efficacy of the patients was evaluated.Survival curve was drawn.Univariate and multivariate analyses were performed.Results The receiver operating characteristic(ROC)curve was used to calculate the Youden index,and the best cut-off value of PNI was 44.65.Patients were divided into low PNI group(<44.65)and high PNI group(≥44.65).Patients were divided into poor nutrition group(≥3)and good nutrition group(<3)according to the NRS-2002 assessment form of nutrition risk screening,with 3 points as the critical value.The objective response rate(ORR)of the high PNI group was higher than that of the low PNI group,and the difference was statistically significant(χ^(2)=9.928,P=0.002).The ORR in the good nutrition group was higher than that in the poor nutrition group,and the difference was statistically significant(χ^(2)=12.675,P=0.0001).The overall survival(OS)of the high PNI group was higher than that of the low PNI group,and the OS of the good nutrition group was higher than that of the poor nutrition group.The average OS of high PNI and good nutrition group was 66 months,the survival time was significantly longer than other groups,and the prognosis was the best.The average OS of low PNI and poor nutrition group was 28 months,the survival time was significantly shorter than other groups,and the prognosis was the worst.Univariate and multivariate analysis showed that PNI(P<0.001),nutritional risk screening(P<0.001),age(P=0.027),lymphocyte count(P=0.002),and albumin(P<0.001)were independent risk factors for OS.Conclusion PNI value combined with nutritional status score can be used as clinical prognostic index of DLBCL patients.