预后营养指数对原发性肝癌肝切除术后感染性并发症的预测价值

The predictive value of prognostic nutritional index for post-operative infectious complications in primary hepatocellular carcinoma patients

目的:探讨预后营养指数(PNI)对原发性肝癌肝切除术后感染性并发症的预测价值。方法:回顾性分析2015年2月-2019年11月都江堰医疗中心普外科收治的226例行肝切除术治疗的原发性肝癌患者的临床资料。根据肝切除术后是否合并感染,分为感染组(n=56)和非感染组(n=170)。比较两组临床资料;采用多因素Logistic回归分析肝切除术后感染性并发症的影响因素。绘制受试者工作特征(ROC)曲线,探讨PNI对肝切除术后感染性并发症的评估作用。结果:226例接受肝切除术治疗的原发性肝癌患者中56例(24.78%)术后发生了感染性并发症;两组糖尿病史、术前血清白蛋白、术前淋巴细胞计数、术前PNI、术中失血量、术后胸腔积液、引流管留置时间组间比较差异有统计学意义(P<0.05);多因素Logistic回归分析显示,糖尿病史、术前血清白蛋白、术前PNI、术后胸腔积液、引流管留置时间是肝切除术后感染性并发症发生的独立危险因素(P<0.05);术前PNI预测肝切除术后感染性并发症发生的曲线下面积(AUC)为0.801,敏感度和特异度分别为82.6%、72.5%。结论:术前PNI对肝切除术后感染性并发症具有较好的预测价值。

Objective:To explore the predictive value of prognostic nutritional index(PNI)for infectious complications after hepatectomy for primary hepatocellular carcinoma.Methods:The clinical data of 226 patients with primary liver cancer treated by hepatectomy in general surgery department of Dujiangyan medical center from February 2015 to November 2019 were retrospectively analyzed.According to whether there is infection after hepatectomy,the patients were divided into infection group(n=56)and non-infection group(n=170).The clinical data of the two groups were compared.Multivariate logistic regression was used to analyze the influencing factors of infectious complications after hepatectomy.The receiver operating characteristic(ROC)curve was drawn to explore the role of PNI in the assessment of infectious complications after hepatectomy.Results:56 patients(24.78%)had postoperative infectious complications in 226 patients with primary liver cancer who received hepatectomy.There were significant differences in diabetes history,preoperative serum albumin,preoperative lymphocyte count,preoperative PNI,intraoperative blood loss,postoperative pleural effusion and drainage tube indwelling time between the two groups(P<0.05).Multivariate logistic regression analysis showed that diabetes history,preoperative serum albumin,preoperative PNI,postoperative pleural effusion,drainage tube indwelling time were independent risk factors for postoperative infectious complications(P<0.05).The area under the curve(AUC)of preoperative PNI was 0.801,and the sensitivity and specificity were 82.6%and 72.5%respectively.Conclusion:Preoperative PNI has a good predictive value for infectious complications after hepatectomy.