预后营养指数对急性颅内动脉粥样硬化性大血管闭塞患者预后评估价值分析

Prognostic value of prognostic nutritional index in patients with acute intracranial atherosclerosis-related large vessel occlusion

目的分析预后营养指数(PNI)对急性颅内动脉粥样硬化性大血管闭塞(ICAS-LVO)患者的预后评估价值及影响因素,为相关临床诊疗工作提供更多理论参考。方法选取356例住院治疗的ICAS-LVO患者,采用四分位数法,根据PNI将其分为高值组(PNI≥51.69,144例)和低值组(PNI<51.69,212例),结合随访资料进行回顾性分析。采用多因素logistic回归分析PNI与患者相关指标关系,并用受试者工作特征(ROC)曲线评价PNI的预测效果。结果高值组患者总胆固醇、甘油三酯、高密度脂蛋白胆固醇(HDL-C)、血清白蛋白(ALB)、淋巴细胞计数(LYMPH)、PNI均显著高于低值组,血清总蛋白、改良Rankin量表(MRS)评分均显著低于低值组(P均<0.05)。第6个月的随访结果显示,高值组的ALB、LYMPH、PNI均显著高于低值组,MRS评分及病死率均显著低于低值组(P均<0.05)。Logistic回归分析结果显示总胆固醇[比值比(OR)=1.828,95%置信区间(CD)(1.464,2.491),P=0.027]、甘油三酯[0R=1.603,95%CI(1.233,2.125),P=0.040]、HDL-C[0R=0.419,95%CI(0.262,0.603),P=0.032]、ALB[0R=0.591,95%CI(0.513,0.678),P=0.021]、LYMPH[0R=0.782,95%CI(0.739,0.853),P=0.035]、PNI[0R=0.332,95%CI(0.251,0.469),P=0.003]是ICAS-LVO患者预后不良的影响因素。ROC曲线显示,使用PNI预测的敏感度为82.3%,特异度为71.8%,曲线下面积为0.819,95%CI为0.744~0.915(P<0.001)。结论PNI是评估ICAS-LVO患者远期预后的有效预测指标,可用于鉴别患者的不良预后,为临床治疗提供新思路。

Objective To analyze the prognostic value and influencing factors of prognostic nutritional index(PNI)in patients with acute intracranial atherosclerosis-related large vessel occlusion(ICAS-LVO),so as to provide theoretical references for related clinical diagnosis and treatment.Methods A total of 356 hospitalized patients with ICAS-LVO were selected and divided into a high-value group(PNI≥51.69,144 cases)and a low-value group(PNI<51.69,212 cases)according to PNI by the quartile method.Their follow-up data were analyzed retrospectively.Multivariate logistic regression was used to analyze the relationship between PNI and patient-related indicators,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive effect of PNI.Results The total cholesterol,triacylglycerol,serum albumin(ALB),lymphocyte count(LYMPH)and PNI in the high-value group were higher than those in the low-value group,while the high density lipoprotein-cholesterol(HDL-C),total protein and modified Rankin scale(MRS)scores were lower(all P<0.05).At the 6th month of followup,the ALB,LYMPH and PNI in the high-value group were higher than those in the low-value group,and the MRS score and mortality rate were lower(all P<0.05).Logistic regression analysis showed that total cholesterol[odds ratio(OR)=1.828,95%confidence interval(CI)(1.464,2.491),P=0.027],triacylglycerol[0R=1.603,95%CI(1.233,2.125),P=0.040],HDL-C[0R=0.419,95%CI(0.262,0.603),P=0.032],ALBB[0R=0.591,95%CI(0.513,0.678),P=0.021],LYMPH[0R=0.782,95%CI(0.739,0.853),P=0.035]and PNI[OR=0.332,95%CI(0.251,0.469),P=0.003]were influential factors for poor prognosis of ICAS-LVO patientsT.he ROC curve showed that the sensitivity and specificity of PNI prediction were 82.3%and 71.8%respectively.The area under the curve was 0.819,and the 95%CI was 0.744-0.915(P<0.001).Conclusion PNI is an effective predictor for long-term prognosis in patients with ICAS-LVO,which can be used to identify patients with poor prognosis and provide new ideas for clinical treatment.