HCC患者接受营养干预后BMI、PNI、NPAR水平变化及其对生存质量的影响

摘要/Abstract

摘要： 目的探讨肝细胞癌(HCC)患者接受营养干预后体质指数(BMI)、预后营养指数(PNI)、中性粒细胞/白蛋白比值(NPAR)水平变化及其对生存质量的影响。方法纳入2021年5月至2023年7月就诊于北部战区总医院的原发性肝细胞癌术后患者128例,随机分为营养干预组(n=64)和常规康复组(n=64)。所有患者均接受常规术后康复治疗,营养干预组接受多学科协作诊治下营养干预。比较两组患者一般资料、治疗前后肝功能变化、营养水平变化及免疫功能变化。生活质量量表(SF-36)评估患者生存质量,Spearman相关性分析SF-36评分与治疗后患者肝功能、营养水平指标及免疫功能指标的相关性。结果营养干预组患者CD4⁺/CD8⁺显著高于干预前及常规康复组(1.46±0.13比1.38±0.13,P<0.05),CD4⁺T细胞显著高于干预前,但差异无统计学意义(P>0.05)。干预后血清TP(43.45±3.50)g/L比(38.54±3.57)g/L、Alb(35.48±4.08)g/L比(31.35±3.50)g/L,水平均显著高于干预前及常规康复组患者(P<0.05),血清ALT、AST水平均低于干预前,但差异无统计学意义(P>0.05)。干预后BMI(22.93±1.04)kg/m²比(21.54±1.03)kg/m²、PNI(49.35±3.71比44.89±2.92)水平,均显著高于干预前及常规康复组患者,NPAR(1.30±0.16比1.47±0.15)水平显著低于治疗前及常规康复组患者(P<0.05);干预后平均躯体功能评分(8.64±1.20比7.91±1.11)及SF-36总分均显著高于干预前及常规康复组患者(6.83±1.73比5.98±1.13,P<0.05)。Spearman相关性分析表明HCC术后患者BMI、PNI均与SF-36总分呈显著正相关性(r=0.266、0.304,P<0.05),NPAR与SF-36总分呈显著负相关性(r=-0.322,P<0.05)。结论 HCC术后营养干预有利于改善免疫功能、肝功能及营养水平。接受营养干预的患者生存质量更高,且其改善程度与营养水平恢复程度正相关。

关键词: 肝细胞癌, 营养干预, 预后营养指数, 中性粒细胞百分比/白蛋白比值, 生存质量

Abstract: Objective To examine the alterations in body mass index (BMI), prognostic nutrition index (PNI), neutrophil percentage/albumin ratio (NPAR), as well as their impact on the quality of life among individuals diagnosed with hepatocellular carcinoma (HCC) following nutritional intervention. Methods From May 2021 to July 2023, our hospital treated 128 patients diagnosed with primary HCC. These patients were randomly assorted into a nutrition intervention group (n=64), and a routine rehabilitation group (n=64). All patients underwent standard postoperative rehabilitation procedures, with the nutrition intervention group receiving additional nutritional support through a multi-disciplinary approach to diagnosis and treatment. Various parameters, including general clinical characteristics, liver function indices (including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (Alb), nutritional status indicators (BMI, PNI, and NPAR), as well as immune function markers (such as the proportion of CD4⁺T cells, CD8⁺T cell ratio, and CD4⁺T/CD8⁺T ratio) were gathered and compared between the two groups both before and after the intervention. Moreover, the impact of the intervention on the patients′ quality of life was assessed using the SF-36 scale. Spearman correlation analysis was employed to explore the relationship between SF-36 scores and changes in indicators of liver function, nutritional status, and immune function post-treatment. Results Following the intervention, the nutrition intervention group exhibited a noticeably higher average CD4⁺T/CD8⁺T cell ratio compared to both pre-intervention levels and the routine rehabilitation group (1.46±0.13 vs 1.38±0.13, P<0.05). Additionally, the average CD4⁺T cell ratio of post-intervention levels was markedly elevated compared to pre-intervention levels, with no significant difference observed between the two groups (P>0.05). Furthermore, after intervention, the average serum TP (43.45±3.50 vs 38.54±3.57) and ALB (35.48±4.08 vs 31.35±3.50) levels showed a significant increase from pre-intervention and the routine rehabilitation group (P<0.05), while serum ALT and AST levels also show a noticeable decvease from pre-intervention levels with no significant variance between the two groups (P>0.05). The average serum BMI (22.93±1.04 vs 21.54±1.03) and PNI (49.35±3.71 vs 44.89±2.92) levels after intervention were significantly higher than those before interventionand in the conventional rehabilitation group, whereas the NPAR (1.30±0.16 vs 1.47±0.15) level showed a significant decrease from pre-treatment and routine rehabilitation levels (P<0.05). The average physical function score (8.64±1.20 vs 7.91±1.11) and overall SF-36 score after intervention exhibited a significant improvement compared to pre-intervention levels and those of the routine rehabilitation group (6.83±1.73 vs 5.98±1.13, P<0.05). Spearman correlation analysis indicated a significant positive correlation between BMI, PNI and the total SF-36 score (r=0.266, 0.304, P<0.05), as well as a significant negative correlation between the NPAR score and SF-36 after HCC treatment (r=-0.322, P<0.05). Conclusion Providing nutritional support after HCC surgery can enhance immune function, liver function, and nutritional status. Patients undergoing nutritional intervention reported improved quality of life, with the extent of enhancement being directly linked to the degree of nutritional recovery. These findings underscore the significant clinical relevance of nutritional intervention for HCC postoperative patients.

Key words: Hepatocellular carcinoma, Nutritional intervention, Prognostic nutritional index, Neutrophil percentage/albumin ratio, Quality of life

李龙, 郑振东, 杜成, 刘渤娜. HCC患者接受营养干预后BMI、PNI、NPAR水平变化及其对生存质量的影响[J]. 肝脏, 2025, 30(7): 948-952.

LI Long, ZHENG Zhen-dong, DU Cheng, LIU Bo-na. Changes of BMI, PNI and NPAR levels and their effects on quality of life in patients with HCC after nutritional intervention[J]. Chinese Hepatolgy, 2025, 30(7): 948-952.

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