预后营养指数联合D-二聚体对弥漫大B细胞淋巴瘤患者预后的评估价值

The Prognostic Value of Prognostic Nutritional Index Combined with D-dimer in Patients with Diffuse Large B-Cell Lymphoma

目的:探究预后营养指数(PNI)联合D-二聚体(D-dimer)对初诊弥漫大B细胞淋巴瘤(DLBCL)患者预后的影响。方法:回顾性分析73例DLBCL患者初诊时的临床资料,通过ROC曲线确定PNI和D-dimer的最佳截断值;采用Kaplan-Meier生存曲线比较不同分组患者的总生存(OS)率和无进展生存(PFS)率;采用Cox回归模型进行单变量和多变量分析,确定与OS相关的因素。结果:与低PNI组(PNI<44.775)相比,高PNI组(PNI≥44.775)有更好的OS(P=0.022)和PFS(P=0.029),两组2年OS率分别为55.6%和78.3%(P=0.041);与高D-dimer组(D-dimer≥0.835)相比,低D-dimer组(D-dimer<0.835)具有更好的OS(P<0.001)和PFS(P<0.001),两组2年OS率分别为51.4%和86.8%(P=0.001);同时,高PNI+低D-dimer组患者较其他3组具有更好的OS(P=0.003)和PFS(P<0.001),2年OS率具有统计学差异(P<0.05)。多因素分析结果显示,NCCN-IPI(HR=2.083,95%CI:1.034-4.196,P=0.040)、PNI(HR=0.267,95%CI:0.076-0.940,P=0.040)、PNI+D-dimer(HR=9.082,95%CI:1.329-62.079,P=0.024)是影响DLBCL患者OS的独立危险因素。亚组分析结果发现,PNI、D-dimer、PNI联合D-dimer能够改善低危、低中危DLBCL患者的预后分层。结论:初诊时高PNI、低D-dimer及高PNI+低D-dimer的DLBCL患者具有更好的预后。

Objective:To explore the effects of prognostic nutritional index(PNI)combined with D-dimer on the prognosis of patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods:The clinical data of 73 DLBCL patients at initial diagnosis were retrospectively evaluated,and the optimal cut-of f point of PNI and D-dimer were determined by ROC curve.The overall survival(OS)rate and progression-free survival(PFS)rate in different subgroups were compared using Kaplan-Meier survival curves.Univariate and multivariate Cox regression analysis was performed to identify the factors associated with OS.Results:Compared with the low PNI group(PNI<44.775),the high PNI group(PNI≥44.775)had better OS(P=0.022)and PFS(P=0.029),the 2-year OS rates of the two groups were 55.6%and 78.3%respectively(P=0.041).Compared with the high D-dimer group(D-dimer≥0.835),the low D-dimer group(D-dimer<0.835)had better OS(P<0.001)and PFS(P<0.001),the 2-year OS rates of the two groups were 51.4%and 86.8%respectively(P=0.001).Meanwhile,patients in the high PNI+low D-dimer group had better OS(P=0.003)and PFS(P<0.001)than the other three groups,the 2-year OS rate was statistically different from the other three groups(P<0.05).The multivariate analysis revealed that NCCN-IPI(HR=2.083,95%CI:1.034-4.196,P=0.040),PNI(HR=0.267,95%CI:0.076-0.940,P=0.040)and PNI+D-dimer(HR=9.082,95%CI:1.329-62.079,P=0.024)were the independent risk factors affecting OS in patients with DLBCL.Subgroup analysis showed that PNI,D-dimer,and PNI combined with D-dimer could improve the prognostic stratification in low and low-intermediate risk DLBCL patients.Conclusion:High PNI,low D-dimer and combination of high PNI and low D-dimer at initial diagnosis suggest a better prognosis in DLBCL patients.