目的 探索预后营养指数(PNI)及血清可溶性尿激酶型纤溶酶原激活物受体( suPAR)、胸苷激酶 1(TK1)在晚期肝 癌表达意义以及在预后评估中预测的应用价值。 方法 选取 2019 年 2 月至 2021 年 2 月收集的 92 例晚期肝癌患者进行回顾性 分析,均进行 PNI 评估及血清 suPAR、TK1 检测,比较两组 PNI、suPAR、TK1 水平。 同时,根据患者是否死亡,分为预后不良组 (n = 28,死亡),预后良好组(n = 64,生存),经多因素 Cox 回归模型分析影响晚期肝癌患者预后独立危险因素,经受试者操作特 征(ROC)曲线分析 PNI、suPAR、TK1 的诊断价值。 结果 经单因素分析,血管侵犯、门静脉癌栓会对晚期肝癌预后造成影响 (P<0. 05),且预后不良组 PNI 低于预后良好组,suPAR、TK1 水平高于预后良好组,差异有统计学意义。 Kaplan-Meier 生存分 析显示,PNI 高表达、suPAR 低表达、TK1 低表达、无血管侵犯、无门静脉癌栓者生存时间显著高于 PNI 低表达、suPAR 高表达、 TK1 高表达、有血管侵犯、有门静脉癌栓者,差异有统计学意义(P<0. 05);经多因素 Cox 回归模型分析,PNI 低表达、suPAR 高 表达、TK1 高表达是影响晚期肝癌患者预后的独立危险因素(P<0. 05)。 经 ROC 曲线分析,PNI、suPAR、TK1 及 3 项联合诊断 晚期肝癌预后的曲线下面积分别为 0. 818、0. 827、0. 801、0. 957。 结论 晚期肝癌患者血清 suPAR、TK1 水平升高,PNI 降低, PNI、suPAR、TK1 可作为一项简捷而有效的指标,来协助评估晚期肝癌患者的病情严重程度及预后。

Objective To explore the significance of prognostic nutritional index PNI and serum soluble urokinase - type plasminogen activator receptor suPAR and thymidine kinase 1 TK1 in the expression of advanced hepatocellular carcinoma and its role in prognostic evaluation. Method A retrospective analysis was conducted on 92 patients with advanced liver cancer collected from February 2019 to February 2021 all of whom underwent PNI evaluation and serum suPAR and TK1 detection. The levels of PNI suPAR and TK1 were compared between the two groups. At the same time based on whether the patient died they were divided into a poor prognosis group n = 28 death and a good prognosis group n = 64 survival . After analyzing the independent risk factors affecting the prognosis of advanced liver cancer patients using a multi factor Cox risk model the diagnostic value of PNI suPAR and TK1 was analyzed using receiver operating characteristic ROC curves. Result Through univariate analysis vascular invasion and portal vein thrombosis can have an impact on the prognosis of advanced liver cancer P < 0. 05 and the PNI index of the poor prognosis group is lower than that of the good prognosis group while the levels of suPAR and TK1 are higher than those of the good prognosis group with statistically significant differences. Kaplan Meier survival analysis showed that patients with high expression of PNI low expression of suPAR low expression of TK1 no vascular invasion and no portal vein thrombosis had significantly higher survival time than those with low expression of PNI high expression of suPAR high expression of TK1 vascular invasion and portal vein thrombosis with statistical significance P<0. 05 According to the multi factor Cox risk model analysis low expression of PNI high expression of suPAR and high expression of TK1 are independent risk factors affecting the prognosis of advanced liver cancer patients P<0. 05 . According to ROC curve analysis the area under the curve for PNI suPAR TK1 and the combined diagnosis of advanced liver cancer prognosis were 0. 818 0. 827 0. 801 and 0. 957 respectively. Conclusion As serum suPAR and TK1 levels increased PNI index decreased prognosis nutrition index suPAR and TK1 can be used as a simple and effective index to help evaluate the severity and prognosis of patients with advanced HCC.