目的 探索原发性肝癌患者预后营养指数曲线轨迹并分析其影响因素。 方法 采用便利抽样的方法,选取 2021 年 1 月至 2023 年 12 月南通市第三人民医院收治的诊断为原发性肝癌行手术治疗的 140 例患者为研究对象。 采用一般资料问卷、 预后营养指数分别在术后 1 周内(T1 )、首次放疗后(T2 )、放疗 15 次(T3 )、放疗 30 次或末次(T4 )进行问卷调查。 采用潜在类 别增长模型及单因素分析进行数据处理。 结果 识别出原发性肝癌患者预后营养指数曲线轨迹分为 3 个潜在类别,每个类别 的原发性肝癌患者归属于各个潜在类别的平均概率分别为 0. 946、0. 950、0. 944。 3 个类别分别为营养不良加重组(28. 3%)、 营养状况良好组(55. 8%)、营养不良改善组(15. 9%)。 不同轨迹类别在年龄( χ 2 = 15. 025,P = 0. 005)、婚姻状况( χ 2 = 7. 407, P= 0. 025)、文化程度(χ 2 = 16. 364,P= 0. 012)、肝癌分级(χ 2 = 12. 004,P= 0. 017)、患有慢性病(χ 2 = 7. 887,P= 0. 012)方面,差异 有统计学意义。 结论 本研究通过调查原发性肝癌患者从术后到放疗结束的预后营养指数的变化特征,识别出 3 种不同的曲 线轨迹类型,患者预后营养指数曲线轨迹存在差异。 临床工作人员应密切关注营养不良加重的原发性肝癌患者,及时识别营 养不良的高危患者,有针对性地进行营养治疗,尽最大可能降低营养不良带来的不良事件发生。

Objective To explore the change track of prognostic nutritional index in patients with primary liver cancer and analyze its influencing factors. Method 140 patients diagnosed with primary liver cancer who underwent surgical treatment in the Third People's Hospital of Nantong from January 2021 to December 2023 were selected as the study objects. General data questionnaire and nutritional index were used to investigate within one week after surgery T1 after the first radiotherapy T2 after 15 radiotherapy T3 after 30 radiotherapy or after the last radiotherapy T4 . Latent category growth model and single factor analysis were used for data processing. Result The prognostic nutritional index curve of patients with primary liver cancer was identified to be divided into three potential categories and the average probability of patients in each category belonging to each potential category was 0. 946 0. 950 0. 944 respectively. The three categories were malnutrition plus recombination 28. 3% good nutrition 55. 8% and improved malnutrition 15. 9% . Different locus categories were age χ 2 = 15. 025 P = 0. 005 marital status χ 2 = 7. 407 P = 0. 025 education level χ 2 = 16. 364 P= 0. 012 liver cancer grade χ 2 = 12. 004 P= 0. 017 chronic disease χ 2 = 7. 887 P= 0. 012 the difference was statistically significant. Conclusion By investigating the change characteristics of prognostic nutritional index in patients with primary liver cancer from postoperative to the end of radiotherapy this study identified three different curve trajectories and there were differences in the curve trajectories of prognostic nutritional index in patients. Clinical staff should pay close attention to patients with primary liver cancer caused by malnutrition and recombination timely identify high-risk patients with malnutrition and provide active and targeted nutritional support to reduce the occurrence of adverse events caused by malnutrition as much as possible.