| 摘要: |
| ［摘要］ 目的 探讨术前中性粒细胞与前白蛋白比值（NPRI）水平对行腹腔镜结直肠癌根治术患者近期并发症发生的影响。方法 回顾性分析2015年6月至2017年6月南京医科大学附属泰州市人民医院收治的302例腹腔镜结直肠癌根治术患者的临床资料，根据患者术后近期并发症发生情况将其分为并发症组（n=49）和无并发症组（n=253）。通过多因素logistic回归分析影响患者术后近期并发症发生的因素。通过受试者工作特征（ROC）曲线分析术前NPRI水平预测术后近期并发症发生的效能。分析患者术前NPRI水平与临床特征及术后并发症严重程度的关联性。结果 302例患者中有49例术后发生一种或多种并发症，共计59例次，根据Clavien-Dindo分级系统，发生Ⅰ级术后并发症27例次，Ⅱ级11例次，Ⅲa级6例次，Ⅲb级9例次，Ⅳ级6例次。多因素logistic回归分析结果显示，腹部手术史［OR(95%CI)=2.708(1.077～6.810)］、手术时间长［OR(95%CI)=1.060(1.037～1.084)］、CEA≥5 ng/mL［OR(95%CI)=3.245(1.395～7.549)］以及较高的术前NPRI水平［OR(95%CI)=1.530(1.230～1.904)］是结直肠癌腹腔镜根治术后患者发生近期并发症的独立危险因素。ROC曲线分析结果显示，术前NPRI水平能有效预测结直肠癌患者腹腔镜根治术后近期并发症的发生情况［AUC(95%CI)=0.781(0.700～0.848)，P<0.001］，最佳截断值为3.94，其对应的灵敏度为59.20%，特异度为85.40%。与低NPRI组（<3.94）相比，高NPRI组（≥3.94）的年龄更大，术前血红蛋白水平更低，手术时间更长，肿瘤位于结肠、肿瘤最大直径≥5 cm、肿瘤病理分期为Ⅲ期的人数比例更大，差异有统计学意义（P<0.05）。与低NPRI组相比，高NPRI组术后并发症发生率更高（χ2=47.725，P<0.05），严重并发症发生风险更大（χ2=4.639，P=0.031）。结论 较高的术前NPRI水平是行结直肠癌腹腔镜根治术患者发生近期并发症的危险因素，且与并发症的严重程度存在关联性。 |
| 关键词: 中性粒细胞与前白蛋白比值 结直肠癌 腹腔镜根治术 并发症 |
| DOI：10.3969/j.issn.1674-3806.2024.07.09 |
| 分类号:R 735.3 |
| 基金项目:国家自然科学基金项目（编号：82372746）；江苏省卫生健康委科研项目（编号：M2020084） |
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| Effect of preoperative NPRI level on the occurrence of short-term complications in patients undergoing laparoscopic radical surgery for colorectal cancer |
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XIA Yong1, HU Haoran2, ZHOU Yaxing3, YUAN Yin3, WANG Honggang3
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1.Department of General Surgery, Gaoyou People′s Hospital, Jiangsu 225600, China; 2.Department of General Surgery, Taizhou Fourth People′s Hospital, Jiangsu 225300, China; 3.Department of General Surgery, Jiangsu Taizhou People′s Hospital Affiliated to Nanjing Medical University, Jiangsu 225300, China
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| Abstract: |
| ［Abstract］ Objective To explore the effect of preoperative neutrophil to prealbumin ratio index(NPRI) level on the occurrence of short-term complications in patients undergoing laparoscopic radical surgery for colorectal cancer. Methods The clinical data of 302 patients who were admitted to Jiangsu Taizhou People′s Hospital Affiliated to Nanjing Medical University from June 2015 to June 2017 and underwent laparoscopic radical surgery for colorectal cancer were retrospectively analyzed. The patients were divided into complication group(n=49) and non-complication group(n=253) according to the occurrence of short-term complications after surgery. Multivariate logistic regression was used to analyze the factors affecting the occurrence of short-term complications after surgery in the patients. The receiver operating characteristic(ROC) curve was used to analyze the efficacy of preoperative NPRI level in predicting the occurrence of short-term complications after surgery. The relationship between preoperative NPRI level and clinical features, as well as the severity of postoperative complications in the patients was analyzed. Results Of the 302 patients, 49 patients developed one complication or more complications for a total of 59 complications. According to the Clavien-Dindo grading system, among the 59 complications, 27 complications were grade Ⅰ, and 11 complications were grade Ⅱ, and 6 complications were grade Ⅲa, and 9 complications were grade Ⅲb, and 6 complications were grade Ⅳ. The results of multivariate logistic regression analysis showed that a history of abdominal surgery［OR(95%CI)=2.708(1.077-6.810)］, long operation time［OR(95%CI)=1.060(1.037-1.084)］, CEA≥ 5 ng/mL［OR(95%CI)=3.245(1.395-7.549)］ and higher preoperative NPRI level［OR(95%CI)=1.530(1.230-1.904)］ were independent risk factors for the occurrence of short-term complications in the patients after receiving laparoscopic radical surgery for colorectal cancer. The results of ROC curve analysis showed that preoperative NPRI level could effectively predict the occurrence of short-term complications in the patients after receiving laparoscopic radical surgery for colorectal cancer［AUC(95%CI)=0.781(0.700-0.848), P<0.001］, and the optimal cut-off value was 3.94, with the corresponding sensitivity and specificity being 59.20% and 85.40%, respectively. Compared with the low NPRI group(<3.94), the high NPRI group(≥3.94) had older age, lower preoperative hemoglobin level, longer operation time, and a greater proportion of patients with tumor located in the colon, tumor maximum diameter ≥5 cm and tumor pathological stage Ⅲ, and the differences were statistically significant(P<0.05). Compared with the low NPRI group, the high NPRI group had a higher incidence of postoperative complications(χ2=47.725, P<0.05) and a higher risk of serious complications(χ2=4.639, P=0.031). Conclusion Higher preoperative NPRI level is a risk factor for short-term complications in patients undergoing laparoscopic radical surgery for colorectal cancer and is associated with the severity of complications. |
| Key words: Neutrophil to prealbumin ratio index(NPRI) Colorectal cancer Laparoscopic radical surgery Complication |
