The prognostic significance of nutritional status in patients with diffuse large B cell lymphoma
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摘要:
目的：探讨营养状态指标包括控制营养状态（controlling nutritional status，CONUT）评分和预后营养指数（prognostic nutritional index，PNI）在预测弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma，DLBCL）预后中的作用。方法：回顾性收集105例在南京医科大学附属淮安第一医院血液科就诊的DLBCL患者的临床资料，计算出每个患者的CONUT评分和PNI，并通过ROC 曲线确定截断值。CONUT评分和PNI分别以6.5和47.28作为截断值，将患者根据截断值进行分组。依次进行Kaplan-Meier生存分析、单因素和多因素COX回归分析以及Spearman相关分析。结果：生存曲线显示CONUT评分和PNI对患者的总生存期 （overall survival，OS）具有预测作用（P＜0.05）。单因素分析显示 CONUT 评分、PNI、国际预后指数（international prognostic in- dex，IPI）危险度分型、白蛋白、胆固醇均是患者OS的预后因素。多因素分析结果表明CONUT评分对DLBCL患者的OS具有独立预测作用（HR=2.742，95%CI：1.030~7.300，P＜0.05），PNI不是患者OS的独立预测因素（HR=0.526，95%CI：0.135~2.047，P= 0.35）。相关性分析结果显示两种营养状态指标呈高度负相关（r=-0.79，P＜0.01）。结论：CONUT评分是DLBCL患者预后的独立预测因素，患者CONUT评分越高，预后越差。
Abstract:
Objective：The current study aims to investigate the prognostic role of nutritional status，including controlling nutritional status(CONUT)score and prognostic nutritional index(PNI)，in patients with diffuse large B cell lymphoma(DLBCL). Methods：The clinical data of 105 patients with DLBCL at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University were retrospectively collected. And the patients’CONUT score and PNI were calculated. The cut-off values of CONUT score and PNI were determined by ROC curves，and were 6.5 and 47.28 respectively. The patients were grouped according to the cut-off values. Kaplan- Meier survival analysis，univariate and multivariate COX regression analysis and Spearman correlation analysis were performed sequentially. Results：Survival curves demonstrated that CONUT score and PNI had a predictive effect on OS of patients(P ＜ 0.05). Univariate analysis showed that CONUT score，PNI，IPI risk score，albumin and cholesterol were prognostic factors for OS of patients. The results of multivariate analysis showed that CONUT score had an independent prognostic effect on OS in DLBCL patients(HR= 2.742，95%CI：1.030~7.300，P ＜ 0.05)，and PNI was not an independent prognostic factor for OS of patients(HR=0.526，95%CI： 0.135~2.047，P=0.35). Correlation analysis showed a high negative correlation between the two nutritional status indicators(r=-0.79， P ＜ 0.01). Conclusion：The CONUT score is an independent prognostic factor for DLBCL patients，and the higher the CONUT score of patients，the worse the prognosis.
