目的 分析老年营养风险指数(GNRI)与肝细胞癌经动脉化疗栓塞术(TACE)患者长期预后的关联和临床价值。 方 法 选取 2016 年 6 月至 2019 年 5 月在中国人民解放军总医院第一医学中心行 TACE 的肝细胞癌患者 120 例,按照 3 年生存情 况分为生存组 34 例和死亡组 86 例。 比较两组的临床资料,采用生存函数 Cox 回归分析临床资料对肝细胞癌 TACE 患者长期 预后的影响,并采用 Spearman 分析 GNRI 与肝细胞癌 TACE 患者长期预后的关联。 结果 死亡组年龄(74. 29±2. 30)岁明显高 于生存组(71. 40±3. 29)岁(P<0. 05),死亡组 GNRI(88. 36±3. 69)明显低于生存组(92. 42±3. 54) (P<0. 05),死亡组肿瘤最大 径、肝硬化、远处转移、脉管瘤栓与对照组比较,差异均有统计学意义(P<0. 05)。 死亡组性别、乙型肝炎病毒表面抗原(HBsAg)、丙型肝炎病毒(HCV)、TNM 分期、肿瘤部位、肝功能 Child-Pugh 分级、肿瘤数目、术前甲胎蛋白(AFP)、腹水、侵及肝被 膜、冠心病、高血压、扩张型心肌病、糖尿病、心房颤动、既往脑卒中、高脂血症、吸烟史、饮酒史、TACE 治疗次数与生存组比 较,差异均无统计学意义( P ﹥ 0. 05)。 经 Cox 回归分析,年龄大、肝硬化是肝细胞癌 TACE 患者死亡的影响因素( P < 0. 05),GNRI 高是肝细胞癌 TACE 患者死亡的保护因素(P<0. 05)。 经 Spearman 分析,肝细胞癌 TACE 患者 GNRI 与预后呈负 相关(P<0. 05)。 结论 年龄大、肝硬化、GNRI 低是 TACE 患者死亡的危险因素,GNRI 和 TACE 患者预后可能具有一定关联,早 期评估 GNRI 能够为有效预测患者预后提供科学依据。

Objective The relevance and clinical value between Geriatric nutritional risk index GNRI and long-term prognosis of patients with hepatocellular carcinoma after Transarterial chemoembolization TACE were analyzed. Method A total of 120 patients with hepatocellular carcinoma who received TACE at the First Medical Center of the Chinese People's Liberation Army General Hospital from June 2016 to May 2019 were selected and divided into a survival group 34 cases and a death group 86 cases according to their 3-year survival. The clinical data of the two groups were compared and the influence of clinical data on the long-term prognosis of hepatocellular carcinoma TACE patients was analyzed by Cox regression with survival function and the correlation between GNRI and the long-term prognosis survival time of hepatocellular carcinoma TACE patients was analyzed by Spearman. Result The age of the death group 74. 29±2. 3 was significantly higher than the survival group 71. 40±3. 29 P<0. 05 . The GNRI in the death group 88. 36±3. 69 was significantly lower than that in the survival group 92. 42±3. 54 P<0. 05 . The maximum diameter of tumor cirrhosis distant metastasis and thrombal of vascular tumor in the death group were statistically significant compared with those in the control group P<0. 05 . Death group sex hepatitis B virus surface antigen HBsAg hepatitis C virus HCV TNM stage tumor site liver function Child Pugh grade tumor number AFP ascites invasion of liver capsule coronary heart disease hypertension dilated cardiomyopathy diabetes atrial fibrillation previous stroke hyperlipidemia smoking history drinking history TACE treatment times were not statistically significant compared with survival group P>0. 05 . Cox regression analysis of survival function showed that old age and cirrhosis were risk factors for death in patients with hepatocellular carcinoma treated with TACE P<0. 05 and high GNRI were protective factors for death in patients treated with TACE treated with hepatocellular carcinoma P < 0. 05 . According to Spearman analysis GNRI was positively correlated with survival time of hepatocellular carcinoma patients undergoing TACE P<0. 05 . Conclusion Age cirrhosis and low GNRI are risk factors for death in TACE patients. GNRI may be correlated with the survival time of TACE patients. Early assessment of GNRI can provide a scientific basis for effectively predicting the prognosis of patients.