营养预后指数评估术前营养状态对食管癌术后并发症的预测价值
| 作者: |
1李美端,
1张娟,
1杨胜生,
1黄雪玲
1 解放军福州总医院心胸外科，福州 350025 |
| 通讯: |
黄雪玲
Email: myheart01@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.06.021 |
| 基金: | 福建省科技厅军民共建 ( 社发 ) 项目 (2016Y5005) |
摘要
目的：探讨营养预后指数( prognostic nutritional index，PNI)评估术前营养状态对食管癌术后并发症的预测价值。方法：回顾性分析2016年3月至2017年12月154例食管癌行开胸根治术患者的临床资料，根据PNI划分为低PNI组(PNI<45，中重度营养不良，n=58)和高PNI组(PNI≥45，营养正常或轻度营养不良，n=96)。对比2组术后并发症发生情况，单因素和多因素log i stic回归分析影响食管癌术后并发症的相关因素。结果：本组食管癌患者存在营养不良(PNI<45)的比例为37.7%(58/154)。低PNI组术后总体并发症(60.3% vs 37.5%)、严重并发症(22.4% vs 10.4%)、手术部位感染(29.3% v s 12.5%)、吻合口瘘(20.7% v s 9.4%)发生率显著高于高PNI组，差异均具有统计学意义(P<0.05)。单因素分析发现年龄、基础疾病、病理分期、术中失血量、新辅助放化疗、手术时间、PNI与术后总体并发症有相关性，基础疾病、术中出血量、PNI与术后严重并发症有相关性。多因素logistic回归分析发现基础疾病(OR=1.16，95%CI 0.987~1.413，P=0.048)、低PNI(PNI<45)(OR=2.31，95%CI 1.058~6.821，P=0.036)是术后总体并发症的独立危险因素，低PNI(PNI<45)(OR=2.91，95%CI 1.067~10.131，P=0.040)是术后严重并发症的独立危险因素。 结论：术前低PNI是食管癌开胸根治术后并发症的独立危险因素，临床上可通过PNI评估术前营养状况，必要时术前给予营养支持治疗。
关键词：
营养预后指数；食管癌；开胸切除术；术后并发症；营养不良
Predictive value of prognostic nutritional index for postoperative complications of esophageal cancer
CorrespondingAuthor: HUANG Xueling Email: myheart01@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.06.021
Foundation: This work was supported by Fujian Provincial Military and Civilian Construction (Social Development) Project of Science and Technology Department, China (2016Y5005)
Abstract
Objective: To investigate the predictive value of prognostic nutritional index (PNI) on postoperative complications of esophageal cancer. Methods: The clinical data of 154 patients with esophageal cancer underwent thoracotomy and radical resection from March 2016 to December 2017 were retrospectively analyzed and divided into a low-PNI group (PNI <45, moderate to severe malnutrition, n=58) and a high-PNI group (PNI ≥45, normal nutrition or light malnutrition, n=96). The incidence of postoperative complications between the 2 groups was compared. The factors associated with postoperative complications of esophageal cancer were analyzed by singular and multiple factor logistic regression analysis. Results: The proportion of moderate to severe malnutrition (PNI<45) in the series was 37.7% (58/154). In the low-PNI group, the incidence rate of any complications (60.3% vs 37.5%), severe complications (22.4% vs 10.4%), surgical site infection (29.3% vs 12.5%), anastomotic leakage (20.7% vs 9.4%) were significantly higher than those in the high-PNI group (P<0.05). Univariate analysis showed that the age, comorbidity, pathological stage, intraoperative blood loss, neoadjuvant chemoradiotherapy, operation time, and PNI were associated with the overall postoperative complications. Moreover, the comorbidity, intraoperative blood loss, and PNI were associated with severe postoperative complications. Multivariate logistic regression analysis showed that the comorbidity (OR=1.16, 95% CI 0.987–1.413, P=0.048) and the low PNI (PNI<45) (OR=2.31, 95% CI 1.058–6.821, P=0.036) were the independent risk factors of any morbidity, and only the low PNI (PNI<45) (OR=2.91, 95% CI 1.067–10.131, P=0.040) was an independent risk factor for severe morbidity. Conclusion: Preoperative low PNI index is an independent risk factor for postoperative complications of esophageal cancer underwent thoracotomy and radical resection. The preoperative nutritional status can be assessed by PNI, and preoperative nutritional support should be given if necessary.
Keywords：
prognostic nutritional index; esophageal cancer; thoracotomy; postoperative complications; malnutrition