术前NLR、LMR、PNI值对胰十二指肠切除术后胰瘘发生的预测价值

目的:探讨术前预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)对患者因壶腹周围癌而行胰头十二指肠切除术后发生胰瘘的预测价值。方法:回顾性分析中国医科大学附属盛京医院收治的140例手术切除治疗的壶腹周围癌病例资料。采用受试者工作特征曲线(ROC)、多因素回归分析确定术前NLR、PLR、LMR、PNI对术后胰瘘的预测价值。结果:共筛选出30例术后临床胰瘘(B级瘘和C级瘘)患者,累积发生率为21.43%(30/140)，其中C级瘘为8例，发生率为5.71%(8/140)。术前NLR、PLR、LMR、PNI预测术后胰瘘的最佳截断值分别为3.49、150.79、2.48、44.8。进一步行多因素回归分析得出术前合并糖尿病、NLR≥3.49、LMR<2.48及PNI<44.8是胰头十二指肠切除术后并发胰瘘的独立危险因素(P＜0.05)。术前高NLR(≥3.49)、低PNI(<44.8)的患者术后发生严重的C级胰瘘的可能更大(P＜0.05)。应用胰瘘风险评分系统(FRS)对患者进行分层,其中21例处于高风险层次，进一步分析得到处于高风险层次的患者当同时合并术前高NLR、低PNI与低LMR中多项不良因素时，术后胰瘘的发生率可显著升高(78.57%,P=0.016)。结论:术前高NLR、低LMR、低PNI对胰头十二指肠切除术后患者并发胰瘘具有一定的预测价值；术前NLR、PNI水平与胰瘘的严重程度等级(B级瘘、C级瘘)具有相关性；处于FRS评分高风险层次的PD患者，当同时合并术前高NLR、低PNI与低LMR中多项时，术后发生胰瘘的风险增高。

The predicitive value for postoperative pancreatic fistula using peroperative NLR,LMR and PNI

Objective:To investigate the predictive significance of preoperative PNI,NLR,PLR and LMR for pancreatic fistula (PF) in the peri-ampullary cancer patients who received pancreatoduodenectomy.Methods:The clinical data of 140 cases of peri-ampullary cancer patients who received pancreatoduodenectomy in the Shengjing Hospital of China Medical University were retrospectively analyzed.Receiver operating characteristic curve (ROC),multivariate analysis were used to conduct the predictive significance of preoperative NLR,PLR,LMR and PNI for PF.Results:The incidence of clinically relevant postoperative PF (B and C grade) was 21.43%(30/140) in this cohort.The incidence of grade C was 5.71%(8/140).The cut-off values of preoperative NLR,PLR,LMR and PNI for the prediction of postoperative pancreatic fistula (POPF) were 3.49,150.79,2.48 and 44.8.Patients with diabetes mellitus,NLR≥3.49,LMR<2.48 and PNI<44.8 were demonstrated as the independent risk factors for postoperative PF (P＜0.05,respectively).Patients who combined with preoperative NLR≥3.49 and PNI<44.8 were more likely to occur serious PF (grade C).Patients were stratiffied by the pancreatic fistula risk score system (FRS).The incidence of POPF was significantly increased of patients who were combined with more preoperative risk factors (NLR≥3.49,LMR<2.48 and PNI<44.8) in the high-risk level of FRS (78.57%,P=0.016).Conclusion:Preoperative NLR,LMR and PNI have certain predictive value for POPF in the peri-ampullary cancer patients who received pancreatoduodenectomy.The preoperative NLR and PNI were correlated with the severity of POPF.PF was more likely to occur in the high-risk level of FRS when combined more risk factors (NLR≥3.49,LMR<2.48 and PNI<44.8).