前白蛋白动态变化对胆道支架置入术治疗恶性梗阻性黄疸预后的预测价值

Predictive value of prognosis of prealbumin dynamics in the treatment of malignant obstructive jaundice after biliary stent implantation

目的探讨血清前白蛋白(PAB)动态变化对首次经内镜逆行性胰胆管造影(ERCP)胆道支架置入术治疗恶性梗阻性黄疸(MOJ)患者生存的预测价值。方法回顾性分析首次经ERCP支架置入术解除梗阻的119例MOJ患者的临床资料。根据患者生存期是否大于1年分为生存组和死亡组,收集患者术前及术后7 d的肝功能指标,计算出各指标动态变化率(术后7 d/术前)。利用受试者工作特征(ROC)曲线确定PAB动态变化率的最佳截断值,根据界值将患者分为高低2组,Kaplan-Meier法绘制2组患者的生存曲线,Cox比例风险模型分析影响患者长期生存预后的危险因素。结果119例患者中1年生存率45.4%(54/119),病死率54.6%(65/119)。生存组PAB动态变化率为1.1(0.9,1.4),死亡组为0.9(0.7,1.0),生存组高于死亡组(P<0.05);ROC分析提示PAB动态变化率预测死亡的ROC曲线下面积为0.799(95%CI:0.704~0.895),PAB动态变化率最佳截断值为1.008;生存分析显示低PAB动态变化率组的1年累积生存率低于高PAB动态变化率组(P<0.01)。多因素Cox比例风险模型分析显示,PAB动态变化率较低是MOJ患者ERCP术后长期生存的独立危险因素。结论PAB动态变化率可作为MOJ患者潜在的预后判断指标。

Objective To investigate the predictive value of dynamic changes in serum prealbumin(PAB)in the treatment of malignant obstructive jaundice(MOJ)with the first endoscopic retrograde cholangiopancreatography(ERCP)biliary stenting.Methods The clinical data of 119 patients with MOJ who were relieved by ERCP stenting for the first time were retrospectively analyzed.Patients were divided into the survival group and the death group according to whether their survival period was greater than 1 year.The liver function indexes of patients before and 7 days after surgery were collected,and the dynamic change rate of PAB(7 d after surgery/preoperative)was calculated.The receiver operating characteristic(ROC)curve was used to determine the best cut-off value of the dynamic change rate of PAB.Patients were divided into two groups according to the cut-off value.The survival curves of the two groups were plotted by K-M method,and risk factors affecting the long-term survival prognosis of patients were analyzed by the Cox proportional hazard model.Results The 1-year survival rate of 119 patients was 45.4%(54/119)and the case fatality rate was 54.6%(65/119).The dynamic rate of PAB was 1.1(0.9,1.4)in the survival group,and 0.9(0.7,1.0)in the death group,which was significantly higher in the survival group than that in the death group(P<0.05).ROC analysis showed that the area under the ROC curve was 0.799(95%CI:0.704-0.895)and the optimal cut-off value of PAB dynamic rate was 1.008,and the survival analysis showed that the one-year survival rate of the group with high PAB dynamic rate was significantly higher than that in the group with low PAB dynamic rate(P<0.01).Multivariate analysis showed that low dynamic rate of PAB was an independent risk factor for long-term survival of patients with MOJ after ERCP.Conclusion The dynamic rate of PAB can be used as a potential prognostic indicator for MOJ patients.