预后营养指数在B细胞淋巴瘤患者中的疗效预测价值

Clinical significance of prognostic nutritional index in predicting the efficacy in patients with B-cell lymphoma

目的:探讨预后营养指数(prognostic nutritional index,PNI)在B细胞淋巴瘤患者中的疗效预测价值。方法:回顾性分析2013年2月至2018年9月中南大学湘雅三医院初诊的111例B细胞淋巴瘤患者(B细胞淋巴瘤组)和同期本院健康体检中心93例体检者(健康对照组)的临床资料,比较两组人群PNI的差异。通过受试者工作特征(receiver operating characteristic,ROC)曲线确定PNI分界值,依据化学药物治疗(以下简称为化疗)前患者PNI的不同,分为高PNI组(≥43.5)和低PNI组(<43.5),评价两组患者临床病理特征之间的相关性,以及患者化疗前后PNI水平变化与疗效的相关性。结果:B细胞淋巴瘤组PNI值较健康对照组低,差异有统计学意义(P<0.05)。高PNI组和低PNI组患者的乳酸脱氢酶(lactate dehydrogenase,LDH)、是否有B症状、国际预后指数(international prognostic index,IPI)、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分、是否有生发中心来源、疗效比较,差异均有统计学意义(均P<0.05)。低PNI组治疗有效患者PNI均值由化疗前的38.10增高至42.66,差异有统计学意义(t=-2.562,P<0.05),高PNI组治疗无效患者PNI均值由化疗前的50.50降低至41.45,差异有统计学意义(t=3.044,P<0.05)。结论:B细胞淋巴瘤患者PNI水平较健康人群明显降低,且与预后相关临床病理特征有相关性,化疗前后PNI水平的变化可为疗效评价提供一定的依据。

Objective: To investigate the clinical significance of prognostic nutritional index(PNI) in predicting the efficacy in patients with B-cell lymphoma.Methods: The clinical data from 111 patients with B-cell lymphoma(B-cell lymphoma group), who were newly diagnosed in the Third Xiangya Hospital of Central South University from February 2013 to September 2018, were retrospectively analyzed. A total of 93 volunteers selected from the Health Management Center in the Third Xiangya Hospital were set as control, The PNI was compared between the 2 groups. The PNI cut-off value was determined by receiver operating characteristic(ROC) curve analysis. According to the PNI values of patients before chemotherapy, the patients were also divided into a high PNI group(≥43.5) and a low PNI group(<43.5). The correlation of baseline characteristics was evaluated. The correlation between changes in PNI levels and efficacy were evaluated before and after chemotherapy.Results: The PNI value in the B-cell lymphoma group was significantly lower than that in the healthy control group(P<0.05). Lactate dehydrogenase(LDH), presence or absence of B symptoms, international prognostic index(IPI), Eastern Cooperative Oncology Group(ECOG) performance status, source of germinal center, and the efficacy between the high PNI group and the low PNI group were significantly different(all P<0.05). The mean PNI in the effective patients in the low PNI group was increased from 38.10 before chemotherapy to 42.66 after chemotherapy, with significant difference(t=-2.562, P<0.05).The PNI value in the ineffective patients in the high PNI group was decreased from 50.50 before chemotherapy to 41.45 after chemotherapy, with significant difference(t=3.044, P<0.05).Conclusion: The level of PNI in patients with B-cell lymphoma is significantly lower than that in healthy people, and it is related to the baseline characteristics of prognosis. The change of PNI level before and after chemotherapy can provide certain basis for efficacy evaluation.