The predictive value of nutritional risk index in elderly patients with postoperative complications after pancreatoduodenectomy
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摘要:
目的 分析老年人营养风险指数对胰十二指肠切除术(pancreaticoduodenectomy, PD)患者术后并发症的预测价值，旨在为临床老年PD患者围术期的治疗提供借鉴。 方法 选取2018年12月—2019年12月上海交通大学附属瑞金医院胰腺中心收治的择期行胰十二指肠切除术(PD)的120例老年患者纳入研究，收集纳入患者的临床及随访资料。 结果 (1) 120例老年PD患者按照术后并发症发生与否分为并发症发生组(49例)和无并发症发生组(71例)；(2)单因素分析结果显示，老年人营养风险指数(GNRI)、糖尿病史、白蛋白、体重指数、手术时间是老年PD患者术后并发症发生的危险因素；(3)Logistic多因素回归分析结果显示，低GNRI、有糖尿病史以及手术时间长是老年PD患者术后并发症发生的独立危险因素；(4)GNRI预测老年PD患者术后并发症发生的灵敏度为83.26%，特异度为75.25%，阳性预测值为58.96%，阴性预测值为92.86%，曲线下面积为0.801(P=0.003)，临界值为88.7。 结论 GNRI是临床老年PD患者术后并发症发生的独立危险因素，及时、全面、准确、有效的术前营养筛查对于老年PD患者术后并发症的发生具有较好的预测价值，可在临床推广应用。 Abstract:Objective To analyze the predictive value of nutritional risk index for postoperative complications in elderly patients with pancreatoduodenectomy (PD), so as to provide reference for perioperative treatment of elderly patients with PD. Methods Total 120 elderly patients admitted to the General Surgery Department of our hospital for elective pancreatoduodenectomy (PD) from December 2018 to December 2019 were included in the study. Clinical and follow-up data of the included patients were collected comprehensively. Results (1) According to the occurrence of postoperative complications, 120 elderly PD patients were divided into complication group (49 cases) and non-complication group (71 cases). (2) Univariate analysis showed that GNRI, diabetes mellitus, albumin, BMI and operation time were the possible risk factors for postoperative complications in elderly PD patients. (3) Logistic multivariate regression analysis showed that low GNRI, history of diabetes and long operation time were independent risk factors for postoperative complications in elderly PD patients. (4) Value of GNRI in predicting postoperative overall complications in elderly PD patients: sensitivity 83.26%, specificity 75.25%, positive predictive value 58.96%, negative predictive value 92.86%, area under the curve 0.801 (P=0.003), critical value 88.7. Conclusion GNRI is an independent risk factor for postoperative complications in clinical elderly PD patients. Timely, comprehensive, accurate and effective preoperative nutrition screening has a good predictive value for postoperative complications in elderly PD patients and can be applied in clinical practice. -
表 1 老年PD患者术后并发症危险因素的单因素分析(x ±s)
术后并发症 例数 年龄(岁) 性别(例) 高血压史(例) 糖尿病史(例) 体重指数 老年人营养风险指数 男性 女性 无 有 无 有 有 49 69.01±16.54 28 21 24 25 18 31 21.56±1.25 91.52±12.52 无 71 67.45±11.05 40 31 35 36 40 31 23.58±1.78 98.48±13.54 统计量 0.577a 0.008b 0.001b 4.461b -7.303a -2.853a P值 0.566 0.930 0.973 0.035 ＜0.001 0.005 术后并发症 例数 NRS 2002(例) 血红蛋白(g/L) 白细胞(109/L) 淋巴细胞(109/L) 白蛋白(g/L) 手术时间(h) 术中出血量(mL) 有 无 有 49 11 38 125.25±21.01 6.39±1.25 1.48±0.26 33.26±6.25 5.69±2.31 256.15±56.23 无 71 24 47 124.89±24.01 6.41±2.10 1.52±0.31 35.98±6.19 4.25±1.58 265.25±45.18 统计量 1.809b 0.085a -0.065a -0.741a -2.357a 3.794a -0.942a P值 0.179 0.932 0.948 0.460 0.020 ＜0.001 0.349 注：a为t值，b为χ2值。 
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表 3 老年PD患者术后并发症危险因素的多因素分析
因素 B SE Wald χ2 P值 OR值 95% CI 常数项 -15.356 2.970 < 0.001 GNRI -1.942 0.136 5.316 0.030 6.968 1.287~46.958 糖尿病史 0.778 0.065 4.311 0.002 2.177 1.459~4.091 手术时间 -3.265 0.018 17.042 0.036 0.038 0.115~0.570
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