食管癌术前PNI、PALB对术后并发症的预测

Predicion of Preoperative PNI and PALB for Postoperative Complications inPatients Undergoing Esophageal Cancer Surgery

目的 探究食管癌手术患者术前营养预后指数(preoperative nutritional outcome index, PNI)、前白蛋白(prealbumin, PALB)对术后并发症的预测价值研究。方法 回顾性分析2018年1月至2022年3月于南阳南石医院急性食管癌手术的62例食管癌患者,依据对患者随访情况,患者出现术后肺部并发症、手术部位感染、吻合口瘘、心血管并发症等将患者纳入并发症组(21例),其余患者纳入对照组(41例),并发症发生率为33.87%。收集记录两组患者术前PNI、PALB水平并进行比较,采用ROC曲线分析术前PNI、PALB对食管癌手术患者瓣膜置换术后并发症的预测价值。结果 两组患者淋巴是否转移患者占比差异差异存在统计学意义(P<0.05),但两组患者性别、年龄、手术时间、病理类型、肿瘤部位、TNM分期、新辅助化疗、病理形态分型等一般资料比较差异无统计学意义(P>0.05);并发症组患者PNI指数及PALB均低于对照组患者(P<0.05);Logistic回归分析结果显示PNI指数、PALB均为食管癌患者术后并发症的影响因素(P<0.05);单一PNI、PALB指数预测患者预后PNI指数AUC值最高,以42.6为临界值,其预测患者预后的敏感度、特异度分别为71.43%、95.12%,PALB预测患者预后PNI指数AUC值为0.674,以32.7为临界值,其预测患者预后的敏感度、特异度分别为80.95%、58.54%;PNI的AUC值高于PALB的AUC值(P<0.05)。结论 术前PNI、PALB对食管癌手术患者术后并发症具有良好的预测价值,该检测方式值得应用和推广,临床可通过术前PNI、PALB评估患者术后并发症,必要时予以对应干预措施。

Objective To investigate the predictive value of preoperative prognostic nutritional index(PNI)and prealbumin(PALB)for postoperative complications in patients undergoing esophageal cancer surgery.Methods A total of 62 patients who underwent esophageal cancer surgery in Nanshi Hospital of Nanyang between January 2018 and March 2022 were retrospectively analyzed.According to the follow-up of patients,patients with postoperative pulmonary complications,surgical site infection,anastomotic fistula,cardiovascular complications,etc.,were included in the complication group(21 cases),and the remaining patients were included in the control group(41 cases),with a complication rate of 33.87%.Preoperative PNI and PALB levels of patients in the two groups were collected,recorded and compared.ROC curve was used to analyze the predictive value of preoperative PNI and PALB for complications after valve replacement in patients undergoing esophageal cancer surgery.Results There was statistical significance in the proportion of patients with lymphatic metastasis between the two groups(P<0.05),but there was no statistical significance in the general data of gender,age,operation time,pathological type,tumor site,TNM stage,neoadjuvant chemotherapy and pathological morphologic classification between the two groups(P>0.05);PNI index and PALB in complication group were lower than those in control group(P<0.05);Logistic regression analysis showed that PNI index and PALB were influencing factors for postoperative complications of patients with esophageal cancer(P<0.05);the single PNI and PALB index predicted the prognosis of patients with the highest PNI index AUC value,with 42.6 as the critical value,and the sensitivity and specificity of predicting the prognosis of patients were 71.43%and 95.12%,respectively.The PNI index AUC value of predicting the prognosis of patients with PALB was 0.674,with 32.7 as the critical value.The sensitivity and specificity to predict the prognosis were 80.95%and 58.54%,respectively.The AUC value of PNI was higher than that of PALB(P<0.05).Conclusion Preoperative PNI and PALB have good predictive value for postoperative complications in patients with esophageal cancer surgery,and this detection method is worthy of application and promotion.In clinical practice,preoperative PNI and PALB can be used to evaluate postoperative complications of patients,and corresponding intervention measures can be taken if necessary.