预后营养指数对膀胱癌患者根治术后感染的预测价值

Predictive value of prognostic nutritional index on postoperative infection in patients with bladder cancer radical operation

目的探讨预后营养指数(PNI)对膀胱癌患者根治术后发生感染的预测价值。方法回顾性收集接受根治术治疗的145例膀胱癌患者资料,记录术前1周内PNI水平和术后2周内中性粒细胞比率(NEUR)、C反应蛋白(CRP)、白细胞介素6(IL-6)水平。对膀胱癌患者根治术后发生感染的影响因素进行单因素和多因素分析;采用受试者工作特征(ROC)曲线评价PNI对膀胱癌患者根治术后发生感染的预测价值;分析患者术前PNI与术后NEUR、CRP、IL-6水平的相关性。结果本组患者中有19例(13.10%)患者术后出现感染。与非感染组比较,感染组患者年龄较大、PNI水平较低,感染组糖尿病、肾积水、开放手术及大于或等于T3期的发生率高于非感染组(P<0.05)。两组患者性别、组织学类型、组织学分级、肿瘤大小、肿瘤数量及吸烟史、高血压、淋巴结转移、脉管癌栓发生率比较,差异无统计学意义(P>0.05)。logistic回归分析显示,年龄、糖尿病和PNI是膀胱癌患者根治术后发生感染的独立危险因素(P<0.05)。PNI预测膀胱癌患者根治术后发生感染的ROC曲线下面积(AUC)为0.751,95%CI:0.647~0.855,当PNI取值48.7时,约登指数最大(0.437),灵敏度和特异度分别为84.2%和59.5%。Pearson相关分析显示,术前PNI与术后NEUR、CRP、IL-6水平呈负相关(r=-0.453、-0.398、-0.457,P<0.001)。结论PNI对膀胱癌患者根治术后发生感染具有重要的预测价值,且与感染程度存在一定相关性。

Objective To investigate the predictive value of prognostic nutritional index(PNI)on postoperative infection occurrence after radical operation in the patients with bladder cancer(BC)and its correlation with systemic inflammation markers.Methods The data of 145 patients with BC receiving the radical surgery were retrospectively collected.The levels of PNI within preoperative 1 week and the levels of neutrophil ratio(NEUR),C-reactive protein(CRP)and interleukin-6(IL-6)within postoperative 2 weeks were recorded.The univariate and multivariate analysis were performed on the influencing factors of postoperative infection in the patients with BC radical operation.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PNI on the infections occurrence after radical operation in the patients with BC.The correlation between PNI before surgery with NEUR,CRP and IL-6 levels after surgery was analyzed.Results Nineteen patients(13.10%)in this group had postoperative infections.Compared with the non-infection group,the age in the infection group was older and the PNI level was lower(P<0.05).The incidence ratesof diabetes,hydronephrosis,open surgery and occurrence rate of≥T3 stage in the infection group were higher than those in the non-infection group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the gender,histological type,histological grade,tumor size,number of tumors,and incidence of smoking history,hypertension,lymph node metastasis and occurrence rate of vascular cancer thrombus between the two groups(P>0.05).The logistic regression analysis showed that the age,diabetes and PNI were the independent risk factors for postoperative infections in the patients with BC radical resection(P<0.05).The area under the ROC curve of PNI for predicting postoperative infection in the patients BC radical operation was 0.751,and 95%CI was(0.647-0.855).When the PNI value was 48.7,the Jordan index was maximal(0.437),the sensitivity and specificity were 84.2%and 59.5%respectively.The Pearson correlation analysis showed that there was a negative correlation between preoperative PNI and postoperative NEUR,CRP and IL-6 levels(r=-0.453,-0.398,-0.457,P<0.001).Conclusion PNI has an important predictive value for postoperative infections in the patients with BC radical operation,moreover has a certain correlation with the infection degree.