预后营养指数联合中性粒细胞与淋巴细胞比值早期预测胃癌根治术后吻合口漏的临床价值

The clinical significance of prognostic nutritional index combined with neutrophil to lymphocyte ratio in early prediction of anastomotic leakage after radical gastrectomy for gastric cancer

目的研究预后营养指数(PNI)联合中性粒细胞与淋巴细胞比值(NLR)对胃癌根治术后吻合口漏发生的预测价值。方法回顾性收集2016年1月至2020年5月期间在商丘市第三人民医院确诊并接受胃癌根治术治疗的517例胃癌患者的临床资料,分析影响术后吻合口漏发生的危险因素,并探索术后第3天的PNI联合NLR预测吻合口漏发生的临床价值。结果517例胃癌根治术患者中,61例发生吻合口漏,吻合口漏发生率为11.8%。多因素logistic回归分析结果显示,术前合并糖尿病、术中出血量≥400 mL者的吻合口漏发生率较高,且随着术后第3和第5天NLR值的增加以及PNI值的降低,吻合口漏的发生率增加(P<0.05);术后第3天的NLR、PNI单独及二者联合检测预测吻合口漏发生的曲线下面积分别为0.849、0.581和0.949,差异均有统计学意义(P<0.05),联合检测的灵敏度和特异度高于单独指标。结论术后第3天的PNI联合NLR检测对预测胃癌根治术后吻合口漏的发生具有重要的临床意义。

Objective To study the clinical significance of prognostic nutritional index(PNI)combined with neutrophil to lymphocyte ratio(NLR)in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.Methods To retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020,all of the patients received radical gastrectomy.We explored the risk factors that affect the occurrence of postoperative anastomotic leakage,and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.Results Among 517 patients undergoing radical gastrectomy,61 had anastomotic leakage,and the incidence of anastomotic leakage was 11.8%.The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss≥400 mL had a higher incidence of anastomotic leakage,and with the increase of NLR value on the 3 rd and 5 th day after operation,and the decrease of PNI value on the 3 rd and 5 th day after operation,the incidence of anastomotic leakage increased(P<0.05).The area under the curve of NLR,PNI,and NLR combined with PNI on the 3 rd day after operation in predicting the occurrence of anastomotic leakage were 0.849,0.581,and 0.949,respectively,and the differences were statistically significant(P<0.05),the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.Conclusion PNI combined with NLR on the 3 rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.