关键词: 恶性梗阻性黄疸, 经内镜逆行性胰胆管造影术, 胆道支架置入术, C反应蛋白与白蛋白比值, 血小板与淋巴细胞比值

Abstract: Objective To analyze the prognostic value of C-reactive protein/albumin ratio (CAR) combined with platelet to lymphocyte ratio (PLR) in malignant obstructive jaundice (MOJ) after interventional therapy. Methods A total of 87 MOJ patients who underwent interventional therapy in the No.2 People’s Hospital of Fuyang City from May 2020 to February 2023 were retrospectively selected in the study. The patients were divided into good prognosis group and poor prognosis group according to the survival status within 1 year after interventional therapy. CAR and PLR were measured before treatment, and other clinical data were collected to analyze the prognostic factors of patients. The predictive value of CAR and PLR for the prognosis of patients was analyzed by the area under the receiver operating characteristic (ROC) curve (AUC). The survival curve was analyzed by Kaplan-Meier method. Results In the poor prognosis group, age [(66.27±7.22) years vs (62.35±6.91) years], obstruction time > 20 days accounted for [62.50% vs 38.46%], CAR[(1.76±0.34) vs (1.15±0.23)], PLR[(0.77±0.19) vs (0.51±0.13)] and Child-Pugh grade C [31.25% vs 7.69%] were higher than those in good prognosis group, the proportion of anti-tumor after operation [20.83% vs 58.97%] was lower than that in the group with good prognosis (P<0.05). Multivariate stepwise Logistic regression analysis showed that CAR level (OR=6.241, 95%CI: 2.310~16.858), PLR level (OR=4.937, 95%CI: 1.919~12.698), Child-Pugh classification (OR=2.388, 95%CI: 1.174~4.854) were independent risk factors for the prognosis of patients, and postoperative antineoplastic therapy (OR=0.252, 95%CI: 0.112~0.566) was an independent protective factor (P<0.05). ROC curve showed that the sensitivity of CAR, PLR and the combination of the two to predict the prognosis of patients was 70.80%, 75.00%, 89.60%, respectively, the specificity was 74.40%, 71.80%, 87.20%, respectively, and the AUC was 0.794, 0.807, 0.890, respectively (P<0.05). The survival curves of patients with high and low expressions of CAR and PLR were statistically different (P<0.05). Conclusion CAR, PLR are independent risk factors of postoperative outcomes in MOJ patients, through joint determination CAR and PLR level can effectively predict the patients′ prognosis.

Key words: Malignant obstructive jaundice, Endoscopic retrograde cholangiopancreatography, Biliary stent placement, C-reactive protein/albumin ratio, Platelet to lymphocyte ratio