预后营养指数与高血压性脑出血术后30天病死率的关系

Relationship between prognostic nutritional index and 30-day mortality after operation in patients with hypertensive intracerebral hemorrhage

目的 探讨预后营养指数（PNI）与高血压性脑出血术后30 d病死率的关系。方法 回顾性分析252例高血压性脑出血患者的临床资料，计算PNI。结果 252例高血压性脑出血患者中，术后30 d死亡55例，病死率为21.8%。术后30 d死亡患者年龄、血肿体积、丘脑出血率明显高于术后30 d存活患者[（57.5 ± 13.1）岁比（50.9 ± 14.8）岁、（53.12 ± 8.03）ml比（47.23 ± 7.35）ml、83.6%（46/55）比7.1%（14/197）]，术前和术后第3天淋巴细胞计数、术前白蛋白、术前和术后第7天PNI明显低于术后30 d存活患者[（4.67 ± 2.95）× 109/L比（6.22 ± 3.91）× 109/L、（3.49 ± 1.78）× 109/L比（4.81 ± 3.79）× 109/L、（38.71 ± 5.97）g/L比（44.10 ± 5.35）g/L、43.38 ± 6.41比50.32 ± 6.84、35.55 ± 10.89比40.54 ± 6.37]，差异有统计学意义（P〈0.01或〈0.05）。受试者工作特征曲线分析结果显示，术前PNI和术后第7天PNI预测高血压性脑出血患者术后30 d病死率的临界值为44.95和40.30。多因素分析结果显示，术前PNI和术后第7天PNI是影响高血压性脑出血患者术后30 d病死率的独立危险因素（OR= 0.121和0.463，95% CI 0.041~0.359和0.220~0.972，P 〈 0.01或〈0.05）。结论 术前和术后第7天PNI分别≥ 44.95和≥ 40.30是高血压性脑出血患者的保护性因素。

Objective To evaluate the relationship between prognostic nutritional index （PNI） and 30-day mortality after operation in patients with hypertensive intracerebral hemorrhage （HICH）.Methods The clinical data of 252 patients with HICH were retrospectively analyzed, and PNI was calculated.Results Among 252 patients with HICH, 55 cases died within 30 days after operation, and the fatality rate was 21.8%. The age, hematoma volume and thalamic hemorrhage rate in 30-day death after operation patients were significantly higher than those in survival patients： （57.5 ± 13.1） years vs. （50.9 ± 14.8） years, （53.12 ± 8.03） ml vs. （47.23 ± 7.35） ml and 83.6% （46/55） vs. 7.1% （14/197）; the lymphocyte count before operative and third day after operation, albumin levels before operation, PNI levels before operation and seventh day after operation were significantly lower than those of survival patients： （4.67 ± 2.95） × 109/L vs. （6.22 ± 3.91） × 109/L, （3.49 ± 1.78） × 109/L vs. （4.81 ± 3.79） × 109/L, （38.71 ± 5.97） g/L vs. （44.10 ± 5.35） g/L, 43.38 ± 6.41 vs. 50.32 ± 6.84 and 35.55 ± 10.89 vs. 40.54 ± 6.37, and there were statistical differences （P〈0.01 or〈0.05）. Receiver operating characteristic curve result showed that cut-off values of PNI before operation and seventh day after operation in patients with HICH for predicting 30-day mortality after operation were 44.95 and 40.30. Multivariate analysis result showed that the PNI levels before operation and seventh day after operation were independent risk factors of 30-day mortality after operation in patients with HICH （OR= 0.121 and 0.463, 95% CI 0.041-0.359 and 0.220-0.972, P 〈 0.01 or〈0.05）.Conclusions PNI levels before operation ≥44.95 and seventh day after operation ≥ 40.30 are the favorable factors in patients with HICH.