Hb、Alb及PLR与壶腹周围癌患者胰十二指肠切除术后并发症及临床预后的关系分析

Analysis of the relationship between Hb,Alb,and PLR with postoperative complications and clinical prognosis after pancreaticoduodenectomy

目的分析血红蛋白(Hb)、白蛋白(Alb)、血小板与淋巴细胞比值(PLR)与壶腹周围癌(VPC)患者胰十二指肠切除术(PD)术后并发症及临床预后的关系。方法选取2019年1月—2022年1月徐州市肿瘤医院肝胆胰外科行PD治疗的VPC患者102例为研究对象。术后根据是否发生并发症分为发生组38例和未发生组64例,同时对所有患者均随访1年(失访3例),根据随访结果将患者分为预后不良亚组35例和预后良好亚组64例,比较各组患者Hb、Alb、PLR水平。采用Spearman相关性分析VPC患者Hb、Alb、PLR水平与术后并发症、预后的相关性;Logistic回归分析影响行PD治疗的VPC患者预后的危险因素;绘制受试者工作特征曲线(ROC)分析Hb、Alb、PLR水平对患者预后不良的预测价值。结果发生组患者Hb、Alb水平低于未发生组,PLR水平高于未发生组(t/P=6.454/<0.001、20.333/<0.001、30.371/<0.001);预后不良亚组患者Hb、Alb水平低于预后良好亚组,PLR水平高于预后良好亚组(t/P=11.701/<0.001、26.741/<0.001、31.135/<0.001)。Spearman相关性分析显示,Hb、Alb与行PD治疗的VPC患者术后并发症呈负相关,PLR水平与术后并发症呈正相关(r/P=-0.354/0.002、-0.472/<0.001、0.513/<0.001)。Hb、Alb与VPC患者PD治疗发生预后不良呈负相关,PLR水平与发生预后不良呈正相关(r/P=-0.326/0.003、-0.453/<0.001、0.501/<0.001)。Logistic回归分析显示,Hb低、Alb低、PLR高水平均是影响行PD治疗的VPC患者发生预后不良的危险因素[OR(95%CI)=2.100(1.046~3.154)、2.784(1.352~4.217)、3.463(1.498~5.427)]。ROC曲线显示,Hb低、Alb低、PLR高及三者联合预测患者发生预后不良的ROC曲线下面积(AUC)分别为0.724、0.781、0.801、0.867,三者联合的AUC显著高于单项预测(Z/P=5.071/0.006、5.687/0.001、6.021/<0.001)。结论术前Hb、Alb、PLR水平异常与VPC患者PD术后发生并发症及预后的关系密切,且是影响预后不良的危险因素,三者联合检测对预后不良具有较高的预测价值。

Objective To analyze the relationship between hemoglobin(Hb),albumin(Alb),platelet to lymphocyte ratio(PLR),postoperative complications and clinical prognosis of pancreaticoduodenectomy(PD).Methods From January 2019 to January 2022,102 patients with periampullary carcinoma(VPC)who underwent PD treatment in Hepatobiliary and Pancreatic Surgery Department of Xuzhou Cancer Hospital were selected as the study subjects.After surgery,patients were divided into an occurrence group of 38 cases and a nonoccurrence group of 64 cases based on the occurrence of complications.All patients were followed up for 1 year.According to the follow-up results,patients were divided into a poor prognosis subgroup of 35 cases and a good prognosis subgroup of 64 cases.The Hb,Alb,and PLR levels of patients in each group were compared.Use Spearman correlation analysis to investigate the correlation between Hb,Alb,PLR levels,postoperative complications,and prognosis in VPC patients;Logistic regression analysis of risk factors affecting the prognosis of VPC patients undergoing PD treatment;Draw a receiver operating characteristic curve(ROC)to analyze the predictive value of Hb,Alb,and PLR levels on poor patient prognosis.Results The Hb and Alb levels of patients in the occurrence group were lower than those in the nonoccurrence group,while the PLR levels were higher than those in the nonoccurrence group(t/P=6.454/<0.001,20.333/<0.001,30.371/<0.001);The Hb and Alb levels in patients with poor prognosis subgroup were lower than those in patients with good prognosis subgroup,while PLR levels were higher than those in patients with good prognosis subgroup(t/P=11.701/<0.001,26.741/<0.001,31.135/<0.001).Spearman correlation analysis showed that Hb and Alb were negatively correlated with postoperative complications in VPC patients undergoing PD treatment,while PLR levels were positively correlated with postoperative complications(r/P=-0.354/0.002,-0.472/<0.001,0.513/<0.001).Hb and Alb are negatively correlated with poor prognosis of PD treatment in VPC patients,while PLR levels are positively correlated with poor prognosis(r/P=-0.326/0.003,-0.453/<0.001,0.501/<0.001).Logistic regression analysis showed that low Hb,low Alb,and high PLR were average risk factors for poor prognosis in VPC patients undergoing PD treatment[OR(95%CI)=2.100(1.046-3.154),2.784(1.352-4.217),3.463(1.498-5.427)].The Receiver operating characteristic showed that the area under the Receiver operating characteristic(AUC)predicted by low Hb,low Alb,high PLR and the combination of the three was 0.724,0.781,0.801,0.867,respectively,and the AUC of the combination of the three was higher than the single prediction(Z/P=5.071/0.006,5.687/0.001,6.021/<0.001).Conclusion The abnormal levels of preoperative Hb,Alb,and PLR are closely related to the postoperative complications and prognosis of VPC patients with PD,and are risk factors that affect the poor prognosis of VPC patients after PD surgery.The combined detection of these indicators has high predictive value for the poor prognosis of VPC patients after PD surgery.