小野寺预后营养指数在胃癌患者围手术期营养风险筛查中的应用价值

发布时间：2018-06-25 10:55

本文选题：小野寺预后营养指数 + 受试者工作特征曲线(ROC)　；参考：《扬州大学》2017年硕士论文

【摘要】：目的探讨小野寺预后营养指数(Onoderaprognostic nutritional index,OPNI)在胃癌患者围手术期营养风险评估中的临床应用价值。方法回顾性分析2014年7月至2015年6月期间苏北人民医院连续收治的264例胃癌择期手术患者,同时进行术前Nutrition Risk Screening 2002(NRS2002)评分及OPNI评分。以NRS2002筛查结果为诊断营养风险的金标准(评分≥3分的患者为有营养风险组,评分3分的患者为无营养风险组)。根据患者手术前三天的血常规和血生化检查结果,由血清白蛋白(Alb)和外周血淋巴细胞总数(TLC)计算OPNI= Alb(109/L)+5×TLC(109/L);分别分析NRS2002、OPNI与患者年龄、肿瘤部位、病理类型、TNM分期等临床病理学特征的关系,以NRS2002为标准将营养风险组和无营养风险组的分组结果作为状态变量,OPNI评分为检验变量绘制受试者工作特征曲线(Receiver Operating Characteristic curve,ROC),分析在不同截断点的灵敏度、特异度、约登指数以及曲线下面积以确定OPNI对营养风险评估的最佳截断点,并根据该截断点将病例分为两组,采用Kappa检验比较不同的OPNI截断点与NRS2002营养风险筛查诊断的一致性。同时分析OPNI与患者术后并发症的相关性。结果NRS2002评分3分(无营养风险组)患者146例(55.3%),NRS2002评分≥3分(有营养风险组)患者118例(44.7%)。NRS2002与肿瘤部位、病理类型无关,P0.05。NRS2002评分与患者年龄有关,χ2值12.459,P0.001,Spearman相关性R值0.217。NRS2002评分与T分期有关,χ2值45.534,P0.001,Spearman相关性R值0.051,与N分期有关,χ2值17.618,P0.001,Spearman相关性R值0.059。全组OPNI评分(47.40±7.01分)。绘制ROC曲线显示ROC曲线下面积为0.870(95%CI:0.872～0.919),约登指数最大为0.750时OPNI的临界值为45.6;以此为截断点诊断营养风险的灵敏度为87.7%,特异度为87.2%。以此最佳截断点作为临界值将患者分为OPNI≥45.6组(143例)和OPNI45.6组(121例)两组。OPNI与肿瘤部位、病理类型无相关性,P值0.05。OPNI与患者年龄相关,χ2值10.201,P0.001,Spearman 相关性 R 值 0.061;与患者 T 分期有关,χ2 值 24.719,P0.001,Spearman相关性R值0.056;OPNI与患者N分期有关,χ2值14.053,P=0.003,Spearman相关性R值0.059。kappa检验显示,OPN以45.6为临界值时,OPNI与NRS2002对营养风险筛查具有较好一致性(Kappa= 0.748,p0.001)。分析并发症的发生,我们发现OPNI≥45.6(无营养风险组)143例中,全部行根治性胃癌手术治疗,共有14例发生并发症,其中发生吻合口瘘1例,切口感染4例,切口裂开1例,吻合口出血2例,术后肠梗阻3例,肺部感染3例。OPNI45.6(有营养风险组)121例中,120例行根治性胃癌手术治疗,1例远处转移行胃癌根治联合肝左外叶根治性切除。共有35例发生术后并发症,其中发生吻合口瘘3例,切口感染10例,切口裂开3例,吻合口出血5例,术后肠梗阻7例,肺部感染7例。两组比较差异有统计学意义(P=0.014)。结论OPNI能较好的反映胃癌患者的营养状态、手术风险。对胃癌患者围手术期的营养风险具有较好的诊断和评估价值。OPNI = 45.6可作为营养风险的诊断临界值。
[Abstract]:Objective to evaluate the clinical value of Onoderaprognostic nutritional index (OPNI) in the perioperative nutritional risk assessment of gastric cancer patients. Methods 264 patients with gastric cancer selected from July 2014 to June 2015 were retrospectively analyzed, and the preoperative Nutrition Risk was performed at the same time. The Screening 2002 (NRS2002) score and the OPNI score. The NRS2002 screening result was the gold standard for the diagnosis of nutritional risk. (the patients with a score of more than 3 were a nutritional risk group with a score of 3 points without a nutritional risk group). The results were based on the blood routine and blood biochemical tests at three days before the operation, with serum albumin (Alb) and peripheral blood lymphocytes. The total number (TLC) was calculated by OPNI= Alb (109/L) +5 x TLC (109/L); the relationship between NRS2002, OPNI and the patient's age, tumor site, pathological type, TNM staging and other clinicopathological features were analyzed respectively. The group results of the nutrition risk group and the non nutritional risk group were used as the state variables, and the OPNI score was used as the test variable to draw the subjects' work. Receiver Operating Characteristic curve (ROC), the optimum truncation points of OPNI for nutritional risk assessment were determined at different truncated points, with sensitivity, specificity, Jordan index and the area under the curve, and the cases were divided into two groups according to the truncation point. The Kappa test was used to compare the different OPNI truncation points and the NRS2002 nutritional risk. The consistency of screening diagnosis. Meanwhile, the correlation between OPNI and postoperative complications was analyzed. Results the NRS2002 score was 3 (no nutrition risk group) in 146 cases (55.3%), the NRS2002 score was more than 3 (the nutritional risk group) in 118 cases (44.7%) of the tumor site, the pathological type was not related, the P0.05.NRS2002 score was related to the patient's age, the x 2 value 12.459, P0 .001, Spearman correlation R value 0.217.NRS2002 score is related to T staging. The x 2 value is 45.534, P0.001, Spearman correlation R value 0.051, which is related to N staging. The x 2 value 17.618, P0.001, Spearman correlation R values (47.40 + 7.01). The critical value of OPNI at 50 was 45.6; the sensitivity of the truncation point to diagnose nutritional risk was 87.7%, and the specificity was 87.2%. with the best truncated point as the critical value. The patients were divided into OPNI > 45.6 groups (143 cases) and OPNI45.6 group (121 cases) and two groups of.OPNI and tumor sites, the pathological types were not related, P value 0.05.OPNI was related to the age of the patients, and the x 2 was 10.201, P0.001, Spearman related R value 0.061; related to patients' T staging, x 2 value 24.719, P0.001, Spearman related R value 0.056; OPNI was associated with patients' N staging, 14.053, P=0.003, Spearman correlation R value test showed that 45.6 was critical value (0.74). 8, p0.001. Analysis of the occurrence of complications, we found that 143 cases of OPNI > 45.6 (non nutritional risk group) were all performed radical gastrectomy and 14 cases had complications, including 1 cases of anastomotic fistula, 4 incision infection, 1 incision split, 2 anastomotic bleeding, 3 cases of intestinal obstruction after operation and 3.OPNI45.6 of pulmonary infection (with nutritional risk group). Of the 121 cases, 120 cases were treated with radical gastrectomy, 1 cases of distant metastasis and radical resection of the left lateral lobe of the liver. There were 35 cases of postoperative complications, including 3 cases of anastomotic fistula, 10 incision infection, 3 incision split, 5 anastomotic bleeding, 7 cases of intestinal obstruction after operation and 7 cases of pulmonary infection. The difference of two groups was statistically significant. Significance (P=0.014). Conclusion OPNI can better reflect the nutritional status of gastric cancer patients and the risk of operation. It has a good diagnostic and evaluation value for the perioperative nutritional risk of gastric cancer patients..OPNI = 45.6 can be used as the critical diagnostic value of nutritional risk.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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