预后营养指数与恶性梗阻性黄疸介入治疗后预后的关系:历史性队列研究

Association between prognostic nutritional index and prognosis of patients with malignant obstructive jaundice after interventional therapy:a historical cohort study

目的 探讨预后营养指数(prognostic nutritional index,PNI)与恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)介入治疗后预后的关系。方法 回顾性收集2018年9月至2021年6月期间于西南医科大学附属医院临床确诊为MOJ且行介入治疗患者的临床病理资料;采用X-Tile统计软件确定治疗前PNI的最佳临界值,据此将患者分为高PNI组(PNI≥最佳临界值)和低PNI组(PNI<最佳临界值);比较2组患者的临床病理特征;采用Kaplan-Meier法绘制生存曲线进行生存分析,同时采用Cox比例风险回归模型分析影响MOJ患者预后(预后指标为总生存期)的风险因素。结果 本研究共纳入205例患者。PNI最佳临界值为37.5,高PNI组和低PNI组分别为154例和51例,低PNI组患者中有胆管感染、CA19-9≥400 kU/L、血红蛋白<120 g/L、总胆红素≥300μmol/L、白蛋白<30 g/L及丙氨酸转氨酶<300 U/L患者所占比例较高PNI组更高(均P<0.05),高PNI组和低PNI组患者的中位总生存时间分别为7.1个月和3.6个月,高PNI组的总生存情况优于低PNI组(χ^(2)=18.514,P<0.001)。205例患者的中位随访时间6.2个月,中位总生存期为5.3个月,多因素Cox比例风险回归模型分析结果显示,多次PTCD治疗、联合支架置入、有针对原发肿瘤治疗、术前不合并转移及术前PNI≥37.5的患者介入治疗后OS延长的概率增高(P<0.05)。结论 从本研究结果看,术前外周血PNI与MOJ介入治疗后预后有一定的关系,未来有望用于对MOJ患者的预后预测。

Objective To research the association between the prognostic nutritional index(PNI)and the prognosis of patients with malignant obstructive jaundice(MOJ)after interventional treatment.Methods The clinicopathologic data of patients with MOJ who were clinically diagnosed and underwent interventional treatment in the Affiliated Hospital of Southwest Medical University,from September 2018 to June 2021,were gathered retrospectively.The X-Tile statistical software was used to determine the optimal critical value of PNI before treatment,then the patients were allocated into the high PNI group(PNI was the optimal critical value or more)and low PNI group(PNI was less than the optimal critical value).The clinicopathologic characteristics of the two groups were compared.The Kaplan-Meier method was used to draw survival curve for survival analysis,and the Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with MOJ(the prognostic index was overall survival).Results A total of 205 patients were included in this study.The optimal critical value of PNI was 37.5.There were 154cases in the high PNI group and 51 cases in the low PNI group,respectively.The proportions of the patients with biliary infection,CA19-9≥400 kU/L,hemoglobin 120 g/L,albumin 30 g/L,total bilirubin≥300μmol/L,and alanine aminotransferase 300 U/L were higher in the low PNI group as compared with the high PNI group(P0.05).The median overall survival of patients in the high PNI group and low PNI group was 7.1 months and 3.6 months,respectively.The overall survival curve of the former was better than that the latter(χ^(2)=18.514,P0.001).The median follow-up time of 205patients was 6.2 months,with a median overall survival of 5.3 months.The multivariate results of Cox proportional hazards regression model analysis showed that the probability of overall survival lengthening was increased for the patients with more times of PTCD,with stent implantation,with treatment for primary tumor,without metastasis,and with preoperative PNI≥37.5(P0.05).Conclusion From the results of this study,preoperative peripheral blood PNI has a certain association with the prognosis of patients with MOJ after interventional treatment,and it is expected to be used to predict the prognosis of patients with MOJ in the future.