NRS2002和PNI营养筛查方法在胃癌患者预后中的预测价值

把明勤; 陈柳; 朱小琼; 胡孔旺; 赵存喜

doi:10.16766/j.cnki.issn.1674-4152.003064

NRS2002和PNI营养筛查方法在胃癌患者预后中的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003064

把明勤^{1, 2},
陈柳¹,
朱小琼¹,
胡孔旺³,
赵存喜^1, ,

1.
安徽医科大学公共卫生学院，安徽合肥 230032
2.
安徽省肿瘤医院普外科，安徽合肥 230031
3.
安徽医科大学第一附属医院普外科，安徽合肥 230022

基金项目:

安徽省重点研究与开发计划项目 202004j07020036

详细信息

通讯作者:
赵存喜，E-mail: zhaocx1972@163.com

中图分类号: R735.2 R459.3
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出版历程
- 收稿日期: 2022-12-26
- 网络出版日期: 2023-08-28

Predictive value of NRS2002 and PNI nutritional screening methods in the prognosis of patients with gastric cancer

1.
School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的比较营养风险筛查2002(NRS2002)和预后营养指数(PNI)两种营养筛查方法在胃癌短期预后中的预测价值。方法选取2021年4月—2022年5月安徽省肿瘤医院就诊且进行手术的381例胃癌患者，使用NRS2002和PNI进行术前营养评估，分析与胃癌患者一般临床资料及预后之间的关系；二元logistic回归分析研究营养不良的影响因素。采用受试者工作特征(ROC)曲线下面积(AUC)比较2种方法的预测价值。结果 NRS2002进行术前营养评估得出年龄、TNM分期、分化程度是预后独立影响因素；PNI进行术前营养评估得出患者营养状况与年龄、TNM分期和分化程度是预后独立影响因素。NRS2002和PNI两种营养筛选方法均得出有营养风险组术后住院时间[(11.57±3.73)d vs. (10.19±2.66)d；(11.63±3.65)d vs. (10.16±2.68)d]、住院费用[(51 078±9 204)元vs. (45 574±2 406)元；(50 796±8 992)元vs. (45 635±8 234)元)及术后并发症发生率高于无营养风险组，差异有统计学意义(均P＜0.05)。NRS2002(AUC=0.73)预测效果略优于PNI(AUC=0.68)。结论 NRS2002和PNI两种营养评价方法在预测胃癌患者短期预后方面具有临床价值，且NRS2002的特异度及灵敏度高于PNI。
- 预后营养指数 /
- 营养风险筛查2002 /
- 胃癌 /
- 并发症
Abstract: Objective To compare the predictive value of nutritional risk screening 2002 (NRS2002) and prognostic nutritional index (PNI) in the short-term prognosis of gastric cancer. Methods A total of 381 gastric cancer patients who attended Anhui Cancer Hospital and underwent surgery from April 2021 to May 2022 were selected for preoperative nutritional assessment using NRS2002 and PNI to analyze the relationship with general clinical information and prognosis of gastric cancer patients. Binary logistic regression was used to analyze the influencing factors of malnutrition. The predictive value of two methods was compared using the area under the receiver operating characteristic (ROC) curve (AUC). Results Preoperative nutritional assessment by NRS2002 found that age, TNM stage, and degree of differentiation were independent prognostic factors. Preoperative nutritional assessment by PNI revealed that the patient's nutritional status, age, TNM stage, and degree of differentiation were independent prognostic factors. Both nutritional screening methods showed that the postoperative hospitalization time [(11.57±3.73) days vs. (10.19±2.66) days; (11.63±3.65) days vs. (10.16±2.68) days)], hospitalization costs[(51 078±9 204) ￥ vs. (45 574±2 406)￥; (50 796±8 992)￥ vs. (45 635±8 234)￥, and postoperative complication rate in the group with nutritional risk were higher than those in the group without nutritional risk, and the difference was statistically significant (all P < 0.05). The prediction effect of NRS2002 (AUC=0.73) was slightly better than that of PNI (AUC=0.68). Conclusion NRS2002 and PNI nutritional evaluation methods have clinical value in predicting short-term prognosis of gastric cancer patients, and NRS2002 has higher specificity and sensitivity than PNI.
- Prognostic nutritional index /
- Nutritional risk screening 2002 /
- Gastric cancer /
- Complication

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图 1 NRS2002和PNI预测术后并发症ROC曲线

Figure 1. ROC curve of NRS2002 and PNI predicting postoperative complications

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表 1 术前不同营养状况患者一般资料比较[例(%)]

Table 1. Comparison of general data of patients with different preoperative nutritional status[cases(%)]

一般资料	NRS2002		χ²值	P值	PNI		χ²值	P值
一般资料	≥3分(n=98)	＜3分(n=283)	χ²值	P值	≥45(n=281)	＜45(n=100)	χ²值	P值
性别			0.623	0.430			2.922	0.087
男性	74(26.8)	202(73.2)			197(71.4)	79(28.6)
女性	24(22.9)	81(77.1)			84(80.0)	21(20.0)
年龄			25.499	＜0.001			29.640	＜0.001
≥65岁	80(34.9)	149(65.1)			146(63.8)	83(36.2)
＜65岁	18(11.8)	134(88.2)			135(88.8)	17(11.2)
居住地			0.364	0.546			0.239	0.625
城市	20(28.6)	50(71.4)			50(71.4)	20(28.6)
农村	78(25.1)	233(74.9)			231(74.3)	80(25.7)
合并症			12.218	0.032			7.906	0.161
糖尿病	1(9.1)	10(90.9)			9(81.8)	2(18.2)
高血压	15(19.5)	62(80.5)			61(79.2)	16(20.8)
心脑血管疾病	9(52.9)	8(47.1)			8(47.1)	9(52.9)
呼吸系统疾病	1(33.3)	2(66.7)			2(66.7)	1(33.3)
合并2种及以上	6(16.2)	31(83.8)			27(73.0)	10(27.0)
无	66(28.0)	170(72.0)			174(73.7)	62(26.3)
TNM分期			16.560	＜0.001			11.443	0.003
Ⅰ	20(18.2)	90(81.8)			91(82.7)	19(17.3)
Ⅱ	32(20.8)	122(79.2)			116(75.3)	38(24.7)
Ⅲ	46(39.3)	71(60.7)			74(63.2)	43(36.8)
分化程度			12.258	0.002			8.142	0.007
高分化	3(12.0)	22(88.0)			21(84.0)	4(16.0)
中分化	12(14.0)	74(86.0)			72(83.7)	14(16.3)
低分化	83(30.7)	187(69.3)			188(69.6)	82(30.4)
并发症			60.990	＜0.001			49.751	＜0.001
有	45(61.6)	28(38.4)			30(41.1)	43(58.9)
无	53(17.2)	255(82.8)			251(81.5)	57(18.5)

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表 2 NRS2002及PNI不同分组与临床实验室资料之间的关系

Table 2. Relationship between different NRS2002 and PNI groups and clinical laboratory data

营养分组	例数	血红蛋白(x±s，g/L)		白蛋白(x±s，g/L)		球蛋白(x±s，g/L)		前白蛋白(x±s，g/L)		胆固醇(x±s, mmol/L)
营养分组	例数	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后
NRS≥3分	98	112.90±24.01	108.35±18.72	37.52±4.39	32.18±5.07	23.66±4.17	19.85±3.63	188.60±50.03	112.90±39.71	4.24±0.93	2.94±0.75
NRS＜3分	283	123.22±22.06	114.23±17.17	42.58±3.81	35.46±8.19	24.70±3.85	20.99±3.25	219.27±51.10	134.73±43.09	4.32±0.96	3.14±1.67
统计量		20.316^a	0.002^a	5.269^a	0.626^a	11.128^a	3.999^a	13.413^a	2.997^a	5.776^a	1.225^a
P值		＜0.001	0.961	＜0.001	0.429	＜0.001	0.046	＜0.001	0.084	＜0.001	0.269
PNI≥45	281	124.38±21.03	114.58±16.93	43.05±3.50	35.73±8.21	24.70±3.71	20.93±3.10	220.83±50.30	133.81±41.98	4.37±0.96	3.17±1.68
PNI＜45	100	109.86±24.92	107.47±19.98	36.29±3.23	31.49±4.50	23.70±4.49	20.05±4.05	184.87±49.61	116.01±44.29	4.10±0.91	2.90±0.76
统计量		20.145^a	0.607^a	4.227^a	1.019^a	11.187^a	1.661^a	13.588^a	0.005^a	5.661^a	0.805^a
P值		＜0.001	0.436	＜0.001	0.313	＜0.001	0.198	＜0.001	0.946	＜0.001	0.370

营养分组	例数	白细胞[M(P₂₅, P₇₅)，×10⁹/L]		中性粒细胞[M(P₂₅, P₇₅)，×10⁹/L]		淋巴细胞[M(P₂₅, P₇₅)，×10⁹/L]		住院费用 (x±s, 元)		术后住院时间 (x±s, d)
营养分组	例数	术前	术后	术前	术后	术前	术后	住院费用 (x±s, 元)		术后住院时间 (x±s, d)
NRS≥3分	98	5.16(4.17, 6.33)	11.25(9.22, 13.91)	3.01(2.43, 3.87)	9.90(7.49, 11.97)	1.27(0.95, 1.55)	0.63(0.49, 0.82)	51 078±9 204		11.57±3.73
NRS＜3分	283	5.52(4.57, 6.57)	11.67(8.99, 14.14)	3.34(2.64, 4.19)	10.22(7.42, 12.35)	1.52(1.19, 1.91)	0.72(0.54, 0.97)	45 574±2 406		10.19±2.66
统计量		-1.980^b	0.257^b	-1.260^b	0.008^b	-4.710^b	5.985^b	-3.243^a		-5.147^a
P值		0.050	0.612	0.210	0.928	＜0.001	0.014	＜0.001		＜0.001
PNI≥45	281	5.51(4.57, 6.56)	11.50(8.89, 14.01)	3.29(2.57, 4.01)	9.90(7.41, 12.18)	1.54(1.23, 1.97)	0.73(0.54, 0.97)	45 635±8 234		10.16±2.68
PNI＜45	100	5.24(4.18, 6.38)	11.30(9.27, 14.67)	3.22(2.53, 4.39)	10.00(7.80, 12.83)	1.18(0.89, 1.46)	0.62(0.48, 0.78)	50 796±8 992		11.63±3.65
统计量		-1.690^b	0.089^b	-0.210^b	1.898^b	-7.210^b	9.036^b	-4.997^a		-4.057^a
P值		0.092	0.766	0.838	0.618	＜0.001	0.003	＜0.001		0.001
注：^a为F值，^b为Wald χ²值。

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表 3 胃癌患者营养风险影响因素变量赋值

Table 3. Assignment of variables affecting nutritional risk in patients with gastric cancer

变量	赋值方法
NRS2002	≥3分=1，＜3分=2
PNI	≥45=1，＜45=2
年龄	＜65岁=1，≥65岁=2,
TNM	Ⅲ期=1，Ⅱ期=2，Ⅰ期=3
分化程度	低分化=1，中分化=2，高分化=3
合并症	无=(0，0，0，0)，糖尿病=(1，0，0，0)，高血压=(0，1，0，0)，心脑血管疾病=(0，0，1，0)，呼吸系统疾病=(0，0，0，1)

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表 4 影响胃癌患者NRS2002筛查结果的logistic回归分析

Table 4. Logistic regression analysis affecting NRS2002 screening results in gastric cancer patients

变量	B	SE	Waldχ²	P值	OR(95% CI)
年龄
≥65岁	1.401	0.320	19.176	＜0.001	4.057(2.168~7.594)
TNM分期
Ⅰ期	-0.792	0.360	4.833	0.028	0.453(0.224~0.918)
Ⅱ期	-0.703	0.304	5.337	0.021	0.495(0.273~0.898)
分化程度
高分化	-1.070	0.311	11.812	0.001	0.343(0.186~0.631)
中分化	-0.904	0.274	10.863	0.010	0.405(0.236~0.693)
合并症
糖尿病	1.652	1.127	2.149	0.143	5.271(0.573~47.481)
高血压	0.552	0.361	2.339	0.126	1.737(0.856~3.526)
心脑血管疾病	0.565	0.566	0.995	0.319	0.568(0.187~3.526)
呼吸系统疾病	1.034	1.384	1.463	0.455	0.355(0.024~5.360)
2种及以上	1.112	0.508	4.787	0.029	3.309(1.123~8.226)
注：以NRS2002筛查结果为因变量。合并症以“无”为参照，其余自变量以赋值“1”为参照。

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表 5 影响胃癌患者PNI筛查结果的logistic回归分析

Table 5. Logistic regression analysis affecting PNI screening results in gastric cancer patients

自变量	B	SE	Waldχ²	P值	OR(95% CI)
年龄
≥65岁	1.677	0.327	26.379	＜0.001	5.352(2.822~10.151)
TNM分期
Ⅰ	-0.717	0.358	4.004	0.045	0.488(0.242~0.985)
Ⅱ	-0.263	0.296	0.789	0.769	0.720(0.430~1.374)
分化程度
高分化	-1.024	0.317	10.436	0.001	0.359(0.193~0.669)
中分化	-0.573	0.268	4.581	0.035	0.564(0.334~0.953)
注：以PNI筛查结果为因变量。自变量以赋值“1”为参照。

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表 6 NRS2002和PNI对术后并发症预测比较

Table 6. Comparison between NRS2002 and PNI in predicting postoperative complications

营养筛查方法	最佳截断值	特异度 (%)	灵敏度 (%)	AUC
NRS2002评分	2.5	0.55	0.84	0.73
PNI值	49.4	0.50	0.80	0.68

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