【作者】 李军；

【导师】 陈超武；

【作者基本信息】 湖南师范大学 ， 外科学（专业学位）， 2020， 硕士

【摘要】 目的:研究术前NLR、PLR、SII、PNI等炎性复合指标与肠瘘术后并发症的相关性,并且评估它们对肠瘘术后患者预后的预测效能。方法:回顾性分析湖南省人民医院胃肠外科2015年1月至2019年12月收治的319例肠瘘患者,最终将临床资料齐全且符合入组标准的157例肠瘘患者纳入该研究作为实验组。同时在湖南省人民医院体检中心的所有同期健康体检者中,随机抽取其中157例作为对照组。结果使用SPSS22.0软件进行统计分析,首选利用两独立样本t检验和组间比较采用曼-惠特尼z检验分析,比较实验组(肠瘘组)和对照组(健康组)中NLR、PLR、SII、PNI、降钙素原(PCT)、血清白蛋白、C反应蛋白(CRP)等指标的差异情况。再利用受试者特征曲线(R0C曲线)确定各炎性复合指标的临界值,利用卡方检验分析NLR组、PLR组、SII组及PNI组各高低值组患者之间的术后并发症、术后死亡率和术后住院时间有无差异,即肠瘘患者术前NLR、PLR、SII、PNI各炎性复合指标与肠瘘术后并发症的相关性分析。再利用COX风险比例回归模型对肠瘘患者术前NLR、PLR、SII、PNI各炎性复合指标与肠瘘术后存活情况的关系,进行单因素和多因素分析分析。最后应用ROC曲线下面积(AUC)评估NLR、PLR、SII、PNI对肠瘘患者术后预后的预测效能。结果:1.与对照组(健康组)相比,实验组(肠瘘组)NLR(P<0.001)、PLR(P<0.001)、SII(P<0.001)、CRP(P<0.001)、PCT(P=0.015)值明显升高,而PNI(P<0.001)值、血清白蛋白(P=0.036)明显降低,差异均有统计学意义(P<0.05)。2.本研究157例肠瘘患者均实施开腹手术,术后平均住院时间17天,其中35例(22.29%)住院时间超过17天,术后再次出现肠瘘的患者7例4.46%),术后治疗过程中8例(5.1%)出现腹腔出血,27例(17.2%)术后血培养出现阳性,术后出现肠梗阻13例(8.28%)术后腹腔感染28例(17.83%),术后出现腹部切口愈合不良共31例(19.75%),术后死亡的肠瘘患者5例(3.18%)。相关性分析表明,肠瘘患者的术前NLR、PLR、SII、PNI值与肠瘘确定性手术后住院时间和术后并发症之间有明显相关性,P<0.05。3.单因素回归分析显示,术前NLR(P=0.008)、PLR(P<0.001)、SII(P<0.001)、PNI(P=0.004)、CRP(P=0.049)、PCT(P=0.04)等指标均为影响肠瘘患者术后预后的重要因素(P<0.05)。多因素回归分析表明,PLR(HR=2.364,P=0.04)、PNI(HR=0.095,P=0.023)为影响肠瘘术后预后的独立危险因素。4.ROC曲线分析显示,肠瘘患者术前各炎性复合指标对肠瘘术后预后预测的效能分别为:NLR(AUC=0.632)、PLR(AUC=0.698)、SII(AUC=0.714)、PNI(AUC=0.594)、CRP(AUC=0.468)、PCT(AUC=0.445);我们发现SII(AUC=0.714)曲线下面积最大,因此我们可以认为预后营养指数(SII)是各复合炎性指标中预测肠瘘术后预后的效能最佳,而其他炎性复合指标对肠瘘术后预后的预测有一定价值。结论:1.肠瘘患者术前NLR、PLR、SII值升高或PNI值降低提示其术后并发症发生风险明显升高;2.术前NLR、PLR、SII、PNI炎性复合指标是肠瘘患者术后预后的预测因子,且术前SII评估效能最佳。更多还原

【Abstract】 Objective: To study the correlation of preoperative NLR,PLR,SII,PNI and other inflammatory composite indexes with postoperative complications of intestinal fistula,and to evaluate their predictive efficacy for the prognosis of patients after intestinal fistula.Methods: A retrospective analysis of 319 patients with intestinal fistula admitted to the Department of Gastrointestinal Surgery,Hunan Provincial People’s Hospital from January 2015 to December 2019,and finally included 157 patients with intestinal fistula patients with complete clinical data and meeting the inclusion criteria were included in the study as an experimental group.At the same time,among all the healthy examinees of the same period in the physical examination center of Hunan Provincial People’s Hospital,157 cases were randomly selected as a control group.At the same time,among all the contemporaneous health check-ups in the Physical Examination Center of Hunan Provincial People’s Hospital,157 cases were randomly selected as the control group.Results SPSS22.0software was used for statistical analysis.The two independent samples t test and the comparison between groups were used to analyze the Mann-Whitney z test.NLR and PLR were compared between the experimental group(intestinal fistula group)and the control group(healthy group),SII,PNI,procalcitonin(PCT),serum albumin,C-reactive protein(CRP)and other indicators.Then use the receiver characteristic curve(ROC curve)to determine the critical value of each inflammatory composite index,and use the chi-square test to analyze the postoperative complications,high-and low-value group patients in the NLR group,PLR group,SII group and PNI group.There was no difference in postoperative mortality and postoperative hospital stay,that is,the correlation analysis of the inflammatory composite indexes of NLR,PLR,SII,PNI and postoperative complications of intestinal fistula in patients with intestinal fistula.Then use the COX risk proportional regression model to analyze the relationship between the preoperative NLR,PLR,SII,and PNI inflammatory composite indexes of patients with intestinal fistula and postoperative survival of intestinal fistula.Finally,the area under the ROC curve(AUC)was used to evaluate the predictive efficacy of NLR,PLR,SII,and PNI in the prognosis of patients with intestinal fistula.Results: 1.Compared with the control group(healthy group),the experimental group(intestinal fistula group)NLR(P <0.001),PLR(P<0.001),SII(P <0.001),CRP(P <0.001),PCT(P = 0.015)value increased significantly,while PNI(P <0.001)value and serum albumin(P= 0.036)decreased significantly,the difference was statistically significant(P <0.05).2.All 157 patients with intestinal fistula in this study underwent laparotomy,and the average hospital stay was 17 days after operation,of which 35(22.29%)were hospitalized for more than 17 days,and 7patients with intestinal fistula recurred after operation(4.46%),In the course of postoperative treatment,8 cases(5.1%)developed intra-abdominal hemorrhage,27 cases(17.2%)showed positive postoperative blood culture,and 13 cases(8.28%)developed postoperative intestinal obstruction.28 cases(17.83%)suffered post-abdominal infection.A total of 31 patients(19.75%)suffered from poor abdominal incision healing after operation,and 5 patients(3.18%)died of intestinal fistula after operation.Correlation analysis showed that the preoperative NLR,PLR,SII,and PNI values of patients with intestinal fistula were significantly correlated with the hospital stay after definitive operation of intestinal fistula and postoperative complications,P <0.05.3.Single factor regression analysis showed that preoperative NLR(P= 0.008),PLR(P <0.001),SII(P <0.001),PNI(P = 0.004),CRP(P =0.049),PCT(P = 0.04))And other indicators are important factors thataffect the prognosis of patients with intestinal fistula(P <0.05).Multivariate regression analysis showed that PLR(HR = 2.364,P = 0.04)and PNI(HR = 0.095,P = 0.023)were independent risk factors that affected the prognosis of postoperative intestinal fistula.4.ROC curve analysis showed that the efficacy of various inflammatory composite indicators before intestinal fistula patients for predicting the prognosis of postoperative intestinal fistula were: NLR(AUC = 0.632),PLR(AUC = 0.698),SII(AUC = 0.714),PNI(AUC =0.594),CRP(AUC = 0.468),PCT(AUC = 0.445);we found that the area under the curve of SII(AUC = 0.714)is the largest,so we can consider the prognostic nutrition index(SII)to be a composite inflammatory index Medium predicts the efficacy of postoperative prognosis of intestinal fistula,and other inflammatory composite indicators have certain value in predicting the prognosis of postoperative intestinal fistula.Conclusion:1.Increased NLR,PLR,SII value or decreased PNI value before operation in patients with intestinal fistula indicates that the risk of postoperative complications is significantly increased;2.The pre-operative NLR,PLR,SII,PNI inflammatory composite indexes are the predictors of postoperative prognosis of patients with intestinal fistula,and the preoperative SII assessment efficiency is the best.更多还原