Multiple Solutions for a Class of Singular Boundary Value Problems of Hadamard Fractional Differential Systems with p-Laplacian Operator

This paper discusses the existence and multiplicity of positive solutions for a class of singular boundary value problems of Hadamard fractional differential systems involving the p-Laplacian operator. First, for the sake of overcoming the singularity, sequences of approximate solutions to the boundary value problem are obtained by applying the fixed point index theory on the cone. Next, it is demonstrated that these sequences of approximate solutions are uniformly bounded and equicontinuous. The main results are then established through the Ascoli-Arzelà theorem. Ultimately, an instance is worked out to test and verify the validity of the main results.

Monitoring Multiple Cropping Index of Henan Province, China Based on MODIS-EVI Time Series Data and Savitzky-Golay Filtering Algorithm

Multiple cropping index(MCI)is a very important indicator in crop production and agricultural intensification,which represents the utilizing degree of agriculture resources at time scale and the effective utilization situation of arable land.The objective of this paper is monitoring multiple cropping index of Henan province of China according to the time series of MODIS(Moderate-Resolution Imaging Spectroradiometer)EVI(Enhanced Vegetation Index)after Savitzky-Golay filter processing from the year 2006 to 2011.The results revealed that this method could provide an effective way to monitor multiple cropping index,and the method of no additional authentication data is independent and reliable.The result was accurate and stable,the slope of linear regression of the multiple cropping index between the statistical results and the remote sensing results was 1.0136(R2=0.779).The precision of sample areas validation was 97.91%.Suggesting that the time series MODIS-EVI which after Savitzky-Golay filtering processed,could provide an effective way to extract spatial information of multiple cropping index for management department of agriculture.

FINITE RANGE SET WITH TRUNCATED MULTIPLICITY FOR MEROMORPHIC FUNCTIONS ON SOME COMPLEX DISC

In this paper,we consider the truncated multiplicity finite range set problem of meromorphic functions on some complex disc.By using the value distribution theory of meromorphic functions,we establish a second main theorem for meromorphic functions with finite growth index which share meromorphic functions(may not be small functions).As its application,we also extend the result of a finite range set with truncated multiplicity.

Switching variability index based multiple strategy CFAR detector

A switching variability index （SVl） constant false alarm rate （CFAR） detector is proposed for improving the detection performance of VI-CFAR detectors in multiple targets backgrounds. When the presence of non-homogeneity in CFAR reference windows is indicated by a VI-CFAR detector, a switching- CFAR detector is introduced to optimize the performance of the VI-CFAR detector in homogeneous, multiple targets and clutter edge backgrounds. The structure and parameters selection method of the SVI-CFAR detector is presented. Comparisons with classic CFAR detectors and recently proposed detectors are also given. Theoretical analysis and simulation results show that SVICFAR detector maintains the good performance of the VI-CFAR detector in homogeneous and clutter edge backgrounds, while greatly improving the capacity of anti-multi targets.

Spatial Exploration of Multiple Cropping Efficiency in China Based on Time Series Remote Sensing Data and Econometric Model

This study explored spatial explicit multiple cropping efficiency （MCE） of China in 2005 by coupling time series remote sensing data with an econometric model - stochastic frontier analysis （SFA）. We firstly extracted multiple cropping index （MCI） on the basis of the close relationship between crop phenologies and moderate-resolution imaging spectroradiometer （MODIS） enhanced vegetation index （EVI） value. Then, SFA model was employed to calculate MCE, by considering several indicators of meteorological conditions as inputs of multiple cropping systems and the extracted MCI was the output. The result showed that 46% of the cultivated land in China in 2005 was multiple cropped, including 39% double- cropped land and 7% triple-cropped land. Most of the multiple cropped land was distributed in the south of Great Wall. The total efficiency of multiple cropping in China was 87.61% in 2005. Southwestern China, Ganxin Region, the middle and lower reaches of Yangtze River and Huanghuaihai Plain were the four agricultural zones with the largest rooms for increasing MCI and improving MCE. Fragmental terrain, soil salinization, deficiency of water resources, and loss of labor force were the obstacles for MCE promotion in different zones. The method proposed in this paper is theoretically reliable for MCE extraction, whereas further studies are need to be done to investigate the most proper indicators of meteorological conditions as the inputs of multiple cropping systems.

Existence of Multiple Positive Solutions for Singular Impulsive Boundary Value Problems in Banach Space

In this paper, we first obtain some new results about the existence of multiple positive solutions for singular impulsive boundary value problems, and then to illustrate our main results we studied the existence of multiple positive solutions for an infinite system of scalar equations.

^(18)F-FDG PET/CT imaging for a gastrointestinal mantle cell lymphoma with multiple lymphomatous polyposis

Multiple lymphomatous polyposis(MLP)is an uncommon type of gastrointestinal lymphoma characterized by the presence of multiple polyps along the gastrointestinal tract.Most of this entity is in fact considered the counterpart of gastrointestinal tract involvement for mantle cell lymphoma(MCL).To our knowledge,there have been no reports on[fluorine-18]-fluorodeoxy-glucose(18F-FDG)-positron emission tomography(PET)/computed tomography(CT)imaging for gastrointestinal MCL with MLP.We present the results of 18F-FDG PET/CT imaging in a patient with gastrointestinal tract involvement of MCL showing continuous MLP from the stomach to the rectum and intestinal intussusception.FDG-PET/CT findings were false negative in typical MLP spreading widely over the gastrointestinal tract,but uptake was noted in large lesions with deep infiltration considered atypical as MLP.On FDG-PET/CT imaging,the Ki-67proliferative index,which is a cell proliferation marker,showed neither correlation with the presence of uptake nor the maximum standardized uptake value.

Association of low non-invasive near-infrared spectroscopic measurements during initial trauma resuscitation with future development of multiple organ dysfunction

BACKGROUND: Near-infrared spectroscopy(NIRS) non-invasively monitors muscle tissue oxygen saturation(St O2). It may provide a continuous noninvasive measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction(MOD) after severe trauma. We evaluated the correlation between initial St O2 and the development of MOD in multi-trauma patients.METHODS: Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department and meeting standardized trauma-team activation criteria were enrolled in this prospective trial. NIRS monitoring was initiated immediately on arrival with collection of St O2 at the thenar eminence and continued up to 24 hours for those admitted to the Trauma Intensive Care Unit(TICU). Standardized resuscitation laboratory measures and clinical evaluation tools were collected. The primary outcome was the association between initial St O2 and the development of MOD within the f irst 24 hours based on a MOD score of 6 or greater. Descriptive statistical analyses were performed; numeric means, multivariate regression and rank sum comparisons were utilized. Clinicians were blinded from the StO 2 values.RESULTS: Over a 14 month period, 78 patients were enrolled. Mean age was 40.9 years(SD 18.2), 84.4% were male, 76.9% had a blunt trauma mechanism and mean injury severity score(ISS) was 18.5(SD 12.9). Of the 78 patients, 26(33.3%) developed MOD within the first 24 hours. The MOD patients had mean initial St O2 values of 53.3(SD 10.3), signifi cantly lower than those of nonMOD patients 61.1(SD 10.0); P=0.002. The mean ISS among MOD patients was 29.9(SD 11.5), significantly higher than that of non-MODS patients, 12.1(SD 9.1)(P<0.0001). The mean shock index(SI) among MOD patients was 0.92(SD 0.28), also signifi cantly higher than that of non-MODS patients, 0.73(SD 0.19)(P=0.0007). Lactate values were not signifi cantly different between groups.CONCLUSION: Non-invasive, continuous St O2 near-infrared spectroscopy values during initial trauma resuscitation correlate with the later development of multiple organ dysfunction in this patient population.

Predicting pavement condition index based on the utilization of machine learning techniques:A case study

Pavement management systems(PMS)are used by transportation government agencies to promote sustainable development and to keep road pavement conditions above the minimum performance levels at a reasonable cost.To accomplish this objective,the pavement condition is monitored to predict deterioration and determine the need for maintenance or rehabilitation at the appropriate time.The pavement condition index(PCI)is a commonly usedmetric to evaluate the pavement's performance.This research aims to create and evaluate prediction models for PCI values using multiple linear regression(MLR),artificial neural networks(ANN),and fuzzy logic inference(FIS)models for flexible pavement sections.The authors collected field data spans for 2018 and 2021.Eight pavement distress factors were considered inputs for predicting PCI values,such as rutting,fatigue cracking,block cracking,longitudinal cracking,transverse cracking,patching,potholes,and delamination.This study evaluates the performance of the three techniques based on the coefficient of determination,root mean squared error(RMSE),and mean absolute error(MAE).The results show that the R2 values of the ANN models increased by 51.32%,2.02%,36.55%,and 3.02%compared toMLR and FIS(2018 and 2021).The error in the PCI values predicted by the ANNmodel was significantly lower than the errors in the prediction by the FIS and MLR models.

慢性病共病、相位角与老年人肌少症相关的肌肉质量减少的关系研究

目的·探讨慢性非传染性疾病(慢性病)共病、相位角与老年人肌少症相关的肌肉质量减少的相关性,以及慢性病共病、相位角对老年人肌肉质量减少的预测价值。方法·对2018年8月1日—2019年7月31日入住上海交通大学医学院附属仁济医院老年科,年龄≥60岁的患者进行回顾性筛查。收集患者基本情况(性别、年龄、用药数、共病数、有无骨质疏松症、有无吸烟史等),以及实验室检查指标(血红蛋白、白蛋白、血肌酐、血尿酸、铁蛋白、维生素D、三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白等)结果。计算年龄调整后查尔森合并症指数(age-adjusted Charlson comorbidity index,aCCI)。采用InBody S10生物电阻抗身体成分检测仪进行人体成分测试,记录身体质量指数(body mass index,BMI)、骨骼肌质量指数(skeletal muscle mass index,SMI)、相位角(phase angle,PhA)。部分患者接受握力测量。肌肉质量减少采用2019年亚洲肌肉减少症工作组(Asian Working Group for Sarcopenia,AWGS)推荐的SMI值(男性≤7.0 kg/m^(2)、女性≤5.7 kg/m^(2))进行诊断。根据测定的SMI值将患者分为肌肉质量正常组与肌肉质量减少组。采用单因素和多因素Logistic分析老年患者发生肌少症相关的肌肉质量减少的危险因素。并进一步运用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)及曲线下面积评估相关因素预测肌肉质量减少的价值。结果·共入组慢性病共病患者359例,其中男性226例,女性133例;肌肉质量正常组241例,肌肉质量减少组118例,老年人肌少症相关的肌肉质量减少发生率为32.9%。单因素Logistic回归分析提示年龄(OR=1.036,95%CI 1.013~1.060)、共病数(OR=1.117,95%CI1.025~1.217)、aCCI(OR=1.123,95%CI 1.031~1.222)、高密度脂蛋白(OR=3.688,95%CI 2.065~6.622)与老年人肌肉质量减少的风险呈正相关,BMI(OR=0.514,95%CI 0.443~0.597)、PhA(OR=0.195,95%CI 0.126~0.303)、血红蛋白(OR=0.984,95%CI 0.972~0.996)、三酰甘油(OR=0.606,95%CI 0.424~0.866)与老年人肌肉质量减少的风险呈负相关。多因素Logistic回归模型提示PhA(OR=0.338,95%CI 0.119~0.959)、BMI(OR=0.634,95%CI 0.476~0.844)与老年人肌肉质量减少的风险呈负相关。BMI、PhA预测老年人肌少症相关的肌肉质量减少的ROC曲线下面积分别为0.893(95%CI 0.855~0.931)和0.786(95%CI 0.736~0.837),敏感度分别为0.724和0.676,特异度分别为0.916和0.762;BMI联合PhA预测老年人肌肉质量减少的ROC曲线下面积为0.917(95%CI 0.883~0.951),敏感度为0.867,特异度为0.860。结论·aCCI与老年人肌少症相关的肌肉质量减少具有相关性。随着BMI、PhA的下降,老年人肌肉质量减少的风险升高。BMI联合PhA具有较高的老年人肌少症相关的肌肉质量减少的预测价值。未发现慢性病共病对其的预测价值。

基于可持续发展视角我国稀土资源贸易安全评价研究

稀土是支撑高端技术创新和新兴产业发展的关键矿产资源,已经成为大国资源竞争和国际地缘经济政治博弈的重要对象。全球稀土供应链重构进程加剧,如何评估我国稀土资源贸易安全,破解稀土贸易贫困化增长困境,促进稀土产业可持续发展,是当前亟须关注和解决的重要课题。本研究基于“压力—状态—响应”模型(Pressure-State-Response Model)构建稀土贸易安全评价指标体系,测算不同时期我国稀土资源的压力指数、状态指数、响应指数,揭示我国稀土贸易安全指数演变特征,进一步建立多元线性回归模型,识别我国稀土贸易安全的影响因素。研究发现:我国稀土资源贸易安全度在持续下降,亟需优化贸易结构,降低供应链风险;我国稀土资源贸易的驱动因素主要来源于市场需求牵引、资源禀赋优势以及产业有序供给;全球稀土产业分工格局、资源价值核算方法缺失,限制了我国稀土资源贸易可持续发展。在此基础上,提出通过健全稀土资源收储体系、建设再生稀土研发和回收网络等方式,保障战略性稀土资源供给安全;同时,整合稀土行业优势资源与优化稀土产业链及供应链,深度参与全球稀土供应链治理,为我国稀土资源开发利用与可持续发展提供决策依据。

基于力学性能指标与耐久性能指标联合的夯土改性配比优化设计方法

素土强度低、耐久性差且各改性材料掺量往往由工匠凭经验大致确定,导致夯土表面时常容易开裂剥落,故应根据现场土质状况以及合理试验方法来设计夯土改性配比。现有研究大都局限于单一性能指标最优的配比,而现实中夯土既要考虑针对多项力学性能指标与耐久性能指标的同步优化,还要考虑不同地域与气候条件下各指标的重要性不同。另外,现有研究仅能确定若干预设配比中的最优组,而非改性材料预设掺量范围内的最优配比。为此,文章提出一种基于力学性能指标与耐久性能指标联合的夯土改性配比优化设计方法,其包括:(1)土料选用原则与土质鉴定方法;(2)考虑夯土多性能指标的综合赋权方法;(3)基于加权评分和回归分析的夯土改性配比综合比选与优化方法。文章方法通过调整指标权重筛选出适应指标重要性不同时的夯土改性配比,并通过优化设计获得各改性材料预设掺量范围内的最优配比。最后通过设计实例证明了文章方法的确可得到最优的夯土改性配比。

芙蓉李果实成熟期间的综合品质评价指标筛选与表观预测模型构建

目的科学评价芙蓉李果实成熟期间的营养品质,建立色度值表观特征与营养品质的关系。方法以福建省主栽品种芙蓉李为研究对象,对其成熟期间果糖、葡萄糖、蔗糖、苹果酸、奎尼酸、琥珀酸、柠檬酸、富马酸、矢车菊素-3-芸香糖苷、矢车菊素-3-葡萄糖苷、多酚、黄酮、类胡萝卜素等13个品质指标进行分析和综合评价。结果芙蓉李成熟期间,各品质指标的含量变化存在显著差异(P<0.05),综合运用相关分析、因子分析、绝对因子分析-多元线性回归(absolute principal component scores-multiple linear regression,APCS-MLR)分析筛选可反映芙蓉李综合品质的主要指标。因子分析提取出3个主因子,贡献率分别为52.677%、23.468%、11.649%,累计贡献率为87.794%。综合APCS-MLR等数理统计分析,主因子1主要对果糖、矢车菊素-3-芸香糖苷、矢车菊素-3-葡萄糖苷贡献较大,贡献率分别为53.00%、73.85%、55.54%;主因子2主要对蔗糖、富马酸、果糖、柠檬酸的贡献率较大,分别为28.26%、18.70%、16.14%、15.59%;主因子3主要对多酚(29.13%)和黄酮(28.28%)有较大贡献率;选取3个主因子总贡献率高于60%的果糖、葡萄糖、矢车菊素-3-芸香糖苷、矢车菊素-3-葡萄糖苷作为综合品质评价的主要指标。分别对已筛选出的4个主要评价指标与色度值进行多元线性逐步回归分析,建立4个主要指标与色度值的表观预测模型,各模型均具有较好的拟合度,预测值与实测值的均方根误差较小;进一步验证结果表明,通过色度值对4个指标的预测具有较高的可靠性和准确性。结论本研究筛选出的主要指标及预测模型可更加简单、便捷地评价芙蓉李果实成熟期间的综合品质。

无线光通信中大气湍流噪声测量研究

光信号的强度闪烁、光斑漂移、光束扩展、到达角起伏等大气湍流现象会影响光信号在大气中的传输性能。本文将这种闪烁效应看作是光通信系统传输中的乘性噪声,推导了大气湍流乘性噪声模型,并进行了实验测量研究。结果表明:按照晴天、雾霾天、雪天、小雨天、中雨天、大雨天及阴天的顺序,湍流乘性噪声对光通信的通信质量影响加剧,大气折射率结构常数逐渐增大,噪声信号的偏斜度与陡峭度随之增加,导致光强信号的衰落概率变大;同时随着信噪比(signal-to-noise ratio,SNR)的增大,系统的中断概率逐渐减小;而在相同的SNR下,中断概率随着大气折射率结构常数的减小而减小。研究大气湍流噪声对无线光通信系统的影响具有重要的意义,它为大范围、高速的无线光通信技术带来重要的技术突破,对无线光通信技术的发展起到重要的作用。

新型电力系统应对极端事件的风险防范与应急管理关键技术

保障电力安全是贯彻落实总体国家安全观的基本要求。当前,我国电力系统正向新型电力系统演进,新能源不确定性、设备低抗扰与弱支撑性等特征变化叠加日益严峻的极端事件威胁,使得提升电力系统弹性、防范电力安全风险成为一项复杂且具有挑战性的工作。该文在详细介绍新型电力系统弹性提升所面临挑战的基础上,从“风险评估—投资规划—预防准备—响应恢复”4个层面归纳新型电力系统应对极端事件的电力风险防范与应急管理技术,系统分析各层面的关键技术与研究重点。最后,对保障新型电力系统电力安全的实现路径进行展望,提出进一步深入研究的方向。

一种面向多场景的轨迹相似度计算框架

轨迹相似度计算作为轨迹数据分析中的一个研究热点,主要用来衡量两个移动对象轨迹相似程度。已有的轨迹相似度计算工作主要根据不同类型的轨迹数据和应用场景提出了大量轨迹相似性度量方法,但随着轨迹数据采集手段的逐渐丰富和应用需求的发展,在轨迹相似性计算方面却缺少一个统一的框架以支持多样化轨迹数据下的相似轨迹分析。为此,本文在综合分析已有相似轨迹度量方法共性特征基础上,提出了一个兼容多种轨迹相似度度量方法的集成计算框架(Multiple Scenarios Similarity Trajectory Framework,MSSTJ),并通过一种统一的轨迹数据分区索引方法来优化不同相似轨迹度量方法的计算效率,从而使得用户可以通过参数化配置的简单方式来实现不同场景下多样化的轨迹相似度高效计算的需求。通过基于两类不同类型轨迹数据集的相关实验表明,MSSTJ可以帮助用户快速实现不同的轨迹相似度计算算法,并且实现的算法具有较好的性能表现。

基于无人机影像多时相的小麦品种氮效率分类识别

【目的】探索无人机遥感在氮效率分类识别中的潜力,构建小麦品种氮效率分类方法,为氮高效品种筛选提供理论依据和技术支持。【方法】通过6个成熟期与氮效率密切相关的农学指标(产量、植株氮积累、氮素生理利用效率、植株干生物量、籽粒总吸氮量、N收获指数)构建主成分综合值,并对其进行K-Means聚类分析,将121个小麦品种划分为氮高效型、氮中效型和氮低效型3种类型。利用无人机遥感平台搭载多光谱相机,在小麦拔节期、孕穗期和开花期获取无人机遥感影像,并提取34种植被指数,分析植被指数与氮效率综合值的相关性;对比支持向量机(SVM)、随机森林(RF)和K最近邻(KNN)分类方法的氮效率分类模型精度,使用总体分类精度(OA)和Kappa系数比较不同生育时期下小麦品种氮效率分类识别的能力;并使用3种不同的特征集筛选方法(ReliefF算法、Boruta算法和RF-RFE算法)对优化的特征子集进行综合评价,确立适宜的小麦品种氮效率分类识别方法。【结果】随着小麦生育时期的不断推进,植被指数与氮效率综合值的相关性逐渐提高,开花期最高(r=0.502);利用植被指数全特征集对小麦品种氮效率进行分类,对于单生育时期数据而言,以开花期的SVM模型分类效果最好(OA=77.1%,Kappa=0.591),拔节期最差(OA=65.6%,Kappa=0.406);总体而言,多生育时期数据融合的品种氮效率分类精度高于单生育时期,其中以拔节期+孕穗期+开花期3个生育时期数据融合的SVM模型的分类效果最优(OA=80.6%,Kappa=0.669)。为减少多生育时期数据融合的特征集变量数量,比较分析RF-RFE、Boruta和ReliefF 3种算法的特征优化效果,基于RF-RFE算法得到的优化特征子集分类精度最高,其OA和Kappa系数比全特征集分类模型分别提高了4.0%和10.1%,其中,以3个生育时期数据融合的分类效果最好(OA=85.4%,Kappa=0.749)。【结论】确立6个氮效率指标—主成分分析—K-Means氮效率评价方法;RF-RFE算法有效优化多生育时期组合的特征子集数量,且获得较高的分类精度,确立基于多生育时期组合—RF-RFE—SVM技术融合的小麦品种氮效率分类模型,为小麦氮高效品种的快速准确分类鉴定提供理论依据和技术支撑。

基于无人机遥感的多特征组矿区草本植物地上生物量反演

植被地上生物量可作为评价矿山生态修复地生态功能的重要指标,为实现对修复地地上植被生物量快速、准确的预测,以安徽省铜陵市铜官山矿区草本植物地上生物量为研究对象,将无人机高分辨率多光谱影像作为数据源,提取了单波段光谱反射率、植被指数两种光谱特征以及各波段纹理特征变量,并利用高精度DEM(digital elevation model)生成地形特征,再先后使用灰色关联法和熵权法对光谱特征和纹理特征分别进行筛选,进而将筛选出的特征变量和地形特征变量分为光谱特征组和多特征组。采用反向传播神经网络(back propagation neural network,BPNN)、卷积神经网络(convolutional neural network,CNN)以及Elman神经网络3种机器学习算法分别构建基于光谱特征组和多特征组的生物量预测模型,比选精度较高的矿区草本植物地上生物量反演模型。结果表明,在光谱特征基础上引入纹理特征和地形特征后3种反演模型精度都有相应程度提高,其中,基于多特征组构建的BPNN模型表现出最优性能,其决定系数(R2)为0.841,均方根误差为11.813 g·m-2,并同时对3种模型进行交叉验证,进一步证明了基于多特征组的BPNN模型更加稳定,反演精度最优。然后,采用最优反演模型对研究区域内植被生物量进行分级评估,结果显示区内生物量集中于20~40 g·m-2,研究区域内植被生物量整体偏低。研究结果可为矿区草本植物生物量反演研究提供理论支持。

多尺度农业生态系统服务研究进展

农业生态系统服务是由受人类活动深度调控和影响的农业系统产生,其在提供有益生态系统服务的同时,也产生了诸多对人类福祉有负面影响的生态系统负服务。农业生态系统服务和负服务研究不仅关注传统的粮食安全,同时关注与生态安全的共赢,可为实现农业可持续发展提供新的科学视角。基于文献阅读,在明晰农业生态系统服务和负服务内涵及主要特征的基础上,旨在(1)归纳农业生态系统服务和负服务研究的核心尺度和热点议题;(2)梳理多级尺度的典型指标及适用性评估方法;(3)提出未来农业生态系统服务和负服务领域的关键发展方向。农业生态系统服务研究主要涉及田块、景观和区域三个核心尺度,随着尺度扩大,热点议题从关注田块农作物自身,到关注景观异质性及其关联,再到关注区域上与社会系统的结合。农业生态系统除了提供典型或特殊的粮食供给、授粉、杂草防控等服务,同时也带来农业废料、病虫害、生境破损等负服务。对于农业生态系统服务评估,定性和半定量方法通常可适用于多级尺度,而不同定量方法和模型的最佳适用尺度存在差异。未来可重点从时空权衡作用分析、供需和流动机制探索、生态价值实现及生态补偿制定方向为多尺度的农业景观规划与设计提供理论和实践支撑,从生态系统服务视角有效促进农业的可持续发展。

首次复发多发性骨髓瘤中预后营养指数的价值

目的探讨预后营养指数(PNI)对首次复发多发性骨髓瘤(MM)患者预后的影响。方法回顾性分析2016年3月-2023年6月在遂宁市中心医院就诊的101例首次复发的多发性骨髓瘤患者,通过受试者工作特征曲线确定最佳截断值,预后营养指数以41.9为界值将患者分为低PNI组(PNI≤41.9)和高PNI组(PNI>41.9)。分析两组患者年龄、性别、血清钙、血红蛋白、肌酐、乳酸脱氢酶、ISS分期等的差异,并分析相关的预后影响因素。结果低PNI组及高PNI组患者的血红蛋白水平及M蛋白类型差异有统计学意义(P<0.05)。预后营养指数是影响总生存的独立因素。首次复发治疗两个疗程的PNI分组进行无进展生存期(PFS)分析发现,低PNI组的中位PFS显著短于高PNI组(P<0.05)。单因素分析显示,影响多发性骨髓瘤总生存的因素为血钙、乳酸脱氢酶、髓外浆细胞瘤、体能状态评分、初诊时预后营养指数以及首次复发后治疗2疗程的预后营养指数(均P<0.005)。多因素分析显示,初诊时预后营养指数(HR=0.41,95%CI 0.18~0.93)以及首次复发后治疗2疗程的预后营养指数(HR=0.33,95%CI 0.14~0.78)是影响多发性骨髓瘤总生存的独立危险因素。结论初诊及首次复发治疗2疗程后多发性骨髓瘤患者预后营养指数低提示预后不良,是影响预后的独立危险因素。