收稿日期: 2023-02-03
网络出版日期: 2023-09-27
基金资助
江苏省卫生健康委科研项目(H2019082);淮安市科技局支撑项目(HAB202020)
Prognostic analysis of controlling nutritional status and prognostic nutritional index in patients with myelodysplastic syndromes
Received date: 2023-02-03
Online published: 2023-09-27
目的 探讨控制营养状况、预后营养指数（PNI）对骨髓增生异常综合征患者预后作用。 方法 回顾性分析119例骨髓增生异常综合征患者的临床资料，根据受试者工作特征曲线（ROC）计算出观察指标的最佳cut-off值，CONUT评分、PNI分别以4、36.75分界值进行分组，分析各组年龄、性别、血细胞计数、IPSS分组等临床特征及通过单因素和多因素分析其对MDS预后价值。 结果 单因素分析结果显示年龄、血小板计数、骨髓原始细胞计数、IPSS评分、CONUT评分是影响MDS患者OS的危险因素；多因素分析显示，骨髓原始细胞数（HR = 1.06，95%CI：1.01 ~ 1.12，P = 0.028）、CONUT评分（HR = 0.606，95%CI：0.39 ~ 0.95，P = 0.028）是影响MDS患者的OS独立危险因素。 结论 初诊MDS患者CONUT评分高提示预后不良，是影响MDS预后的独立危险因素，而PNI不是MDS预后的独立危险因素。
张权娥 , 陈秋妮 , 陈月 , 张丽娟 , 马晶晶 , 张欣 , 陈侃侃 , 王春玲 , 何正梅 . 控制营养状况、预后营养指数对骨髓增生异常综合征患者预后分析[J]. 实用医学杂志, 2023 , 39(17) : 2204 -2209 . DOI: 10.3969/j.issn.1006-5725.2023.17.009
Objective To explore the impact of controlling nutritional status and prognostic nutritional index on the prognosis of patients with myelodysplastic syndrome. Methods The clinical data of 119 patients with myelodysplastic syndrome treated in the department of Hematology of our hospital from March 2010 to December 2020 were retrospectively analyzed. The optimal cut-off point of observation index was calculated according to the receiver operating characteristic curve （ROC）. CONUT score and PNI were grouped based on the cut-off points of 4 and 36.75， respectively， and the differences between age， gender， blood cell count and IPSS scores were analyzed.The prognostic factors were analyzed via univariate and Cox multivariate regression analyses. Results The univariate analysis revealed that age，platelet count， bone marrow blast cell count， IPSS scores and CONUT were risk factors for the prognosis of patients with MDS. The multivariate analysis revealed that bone marrow blast cell count （HR = 1.06，95%CI：1.01 ~ 1.12，P = 0.028） and CONUT （HR = 0.606，95%CI：0.39 ~ 0.95，P = 0.028） were independent prognosis risk factors of patients with MDS. Conclusions High CONUT score in newly diagnosed MDS patients indicates poor prognosis and is an independent risk factor for MDS prognosis， while PNI is not an independent risk factor for MDS prognosis.
| 1 | 中华医学会血液学分会.骨髓增生异常综合征中国诊断与治疗指南（2019年版）［J］. 中华血液学杂志，2019，40（2）：89-97. |
| 2 | KARANTANOS T， DEZERN A E. Biology and clinical management of hypoplastic MDS： MDS as a bone marrow failure syndrome［J］. Best Pract Res Clin Haematol， 2021，34（2）：101280. |
| 3 | PLATZBECKER U. Treatment of MDS［J］. Blood， 2019，133（10）：1096-1107. |
| 4 | GARCIA-MANERO G. Myelodysplastic syndromes： 2023 update on diagnosis， risk-stratification， and management［J］. Am J Hematol， 2023，98（8）：1307-1325. |
| 5 | XUE W， ZHANG Y， WANG H， et al. Multicenter Study of Controlling Nutritional Status （CONUT） Score as a Prognostic Factor in Patients With HIV-Related Renal Cell Carcinoma［J］. Front Immunol， 2021，12：778746. |
| 6 | SUN W， LI G， ZHANG J， et al. The role of nutritional assessment for predicting radiotherapy-induced adverse events in patients with gastric cancer［J］. Br J Radiol， 2022，95（1130）：20201004. |
| 7 | SENJO H， ONOZAWA M， HIDAKA D， et al. A novel nutritional index "simplified CONUT" and the disease risk index independently stratify prognosis of elderly patients with acute myeloid leukemia［J］. Sci Rep， 2020，10（1）：19400. |
| 8 | SHEN Z， WANG F， HE C， et al. The Value of Prognostic Nutritional Index （PNI） on Newly Diagnosed Diffuse Large B-Cell Lymphoma Patients： A Multicenter Retrospective Study of HHLWG Based on Propensity Score Matched Analysis［J］. J Inflamm Res， 2021，14：5513-5522. |
| 9 | ZHOU X， LU Y， XIA J， et al. Association between baseline Controlling Nutritional Status score and clinical outcomes of patients with multiple myeloma［J］. Cancer Biomark， 2021，32（1）：65-71. |
| 10 | ZHANG Z， PEREIRA S L， LUO M， et al. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults： A Systematic Review and Meta-Analysis［J］. Nutrients， 2017， 9（8）：829. |
| 11 | 方亮， 熊晓云， 方路，等. 基于ESPEN标准探讨四种营养筛查工具对肝细胞肝癌患者的营养评估及预后价值［J］. 实用医学杂志，2020，36（20）：2792-2796，2801. |
| 12 | BASHEER A S， ABAS F， OTHMAN I， et al. Role of Inflammatory Mediators， Macrophages， and Neutrophils in Glioma Maintenance and Progression： Mechanistic Understanding and Potential Therapeutic Applications［J］. Cancers （Basel）， 2021，13（16） ：4226. |
| 13 | LIU B， ZHANG Y， WANG D， et al. Single-cell meta-analyses reveal responses of tumor-reactive CXCL13（+） T cells to immune-checkpoint blockade［J］. Nat Cancer， 2022，3（9）：1123-1136. |
| 14 | BRAUN A， ANDERS H J， GUDERMANN T， et al. Platelet-Cancer Interplay： Molecular Mechanisms and New Therapeutic Avenues［J］. Front Oncol， 2021，11：665534. |
| 15 | OKAMOTO S， URESHINO H， KIDOGUCHI K， et al. Clinical impact of the CONUT score in patients with multiple myeloma［J］. Ann Hematol， 2020，99（1）：113-119. |
| 16 | URESHINO H， KUSABA K， KIDOGUCHI K， et al. Clinical impact of the CONUT score and mogamulizumab in adult T cell leukemia/lymphoma［J］. Ann Hematol， 2019，98（2）：465-471. |
| 17 | BUZBY G P， MULLEN J L， MATTHEWS D C， et al. Prognostic nutritional index in gastrointestinal surgery［J］. Am J Surg， 1980，139（1）：160-167. |
| 18 | TANAKA S， UCHINO J， YOKOI T， et al. Prognostic Nutritional Index and Lung Immune Prognostic Index as Prognostic Predictors for Combination Therapies of Immune Checkpoint Inhibitors and Cytotoxic Anticancer Chemotherapy for Patients with Advanced Non-Small Cell Lung Cancer［J］. Diagnostics （Basel）， 2022，12（2） ：423. |
| 19 | ZHAO P， WU Z， WANG Z， et al. Prognostic role of the prognostic nutritional index in patients with pancreatic cancer who underwent curative resection without preoperative neoadjuvant treatment： A systematic review and meta-analysis［J］. Front Surg， 2022，9：992641. |
| 20 | 梁飞，董雪燕，唐国峰， 等. 预后营养指数、控制营养状况对多发性骨髓瘤患者预后的影响［J］. 中华血液学杂志， 2021，42（4）：332-337. |
| 21 | HE J， YIN H， XIA Y， et al. Prognostic nutritional index， a novel biomarker which predicts worse prognosis in diffuse large B cell lymphoma［J］. Leuk Res， 2021，110：106664. |
| 22 | LU C， CHEN Q， FEI L， et al. Prognostic impact of the controlling nutritional status score in patients with hematologic malignancies: A systematic review and meta?analysis［J］. Front Immunol, 2022，13：952802. |
| 23 | SAITO H， KONO Y， MURAKAMI Y， et al. Influence of prognostic nutritional index and tumor markers on survival in gastric cancer surgery patients［J］. Langenbecks Arch Surg， 2017，402（3）：501-507. |
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