摘要
目的 分析术前中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、系统免疫炎症指数(SⅡ)在乙肝相关性肝癌患者血液中的表达水平,探究影响乙肝相关性肝癌预后的因素.方法 将2018年7月-2019年9月我院收治的乙肝相关性肝癌患者110例纳入研究组,所有患者均接受根治性手术治疗,根据术后3年内是否出现复发、转移及死亡情况,将患者分为预后不良组(42例)和预后良好组(68例).另择同期我院收治的肝脏良性疾病手术患者128例作为对照组,回顾性收集患者临床资料.比较研究组、对照组患者术前NLR、PLR、SⅡ表达水平;分析乙肝相关性肝癌患者预后的影响因素;绘制受试者工作特征曲线(ROC曲线)分析NLR、PLR、SⅡ单独及三者联合检测对乙肝相关性肝癌预后不良的预测价值.结果 研究组患者术前NLR、PLR、SⅡ水平为6.92±2.16、167.90±33.21、432.52±56.22,高于对照组的3.13±0.84、110.11±24.26、326.40±20.35(t=18.310、15.465、19.898,均 P＜0.001).多因素 Logistic 回归分析结果显示,NLR(OR=1.822,95％CI:1.295～2.563)、PLR(OR=1.037,95％CI:1.015～1.060)、SⅡ(OR=1.007,95％CI:1.002～1.012)水平升高为乙肝相关性肝癌预后不良的危险因素(＜0.05).绘制ROC曲线结果显示,NLR、PLR、SⅡ单独及三者联合检测预测乙肝相关性肝癌预后不良的曲线下面积(AUC)分别为0.852、0.862、0.813、0.904(均P＜0.001),灵敏度分别为 80.95％、85.71％、74.16％、82.10％,特异度分别为 77.94％、77.94％、77.94％、95.59％.结论 NLR、PLR、SⅡ升高为乙肝相关性肝癌预后不良的危险因素;乙肝相关性肝癌患者NLR、PLR、SⅡ单独以及三者联合检测有助于预测乙肝相关性肝癌预后.
Abstract
Objective To analyze the expression levels of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammation index(SⅡ)in patients with hepatitis B-related hepatocellular carcinoma and ex-plore the factors influencing its prognosis.Methods A total of 110 patients with hepatitis B-related hepatocellular carcinoma admitted to our hospital from July 2018 to September 2019 were included in the study group.All patients underwent radical surgical treatment.Based on the occurrence of recurrence,metastasis,and death within 3 years after surgery,the patients were assigned to the poor prognosis group(n=42)and the good prognosis group(n=68).Another 128 patients with be-nign liver diseases admitted during the same period were selected as the control group,and their clinical data were retrospec-tively collected.The preoperative NLR,PLR,and SⅡ expression levels were compared between the study group and the control group.The factors influencing the prognosis of patients with hepatitis B-related hepatocellular carcinoma were ana-lyzed.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of NLR,PLR,SⅡ,and their combination in predicting poor prognosis of hepatitis B-related hepatocellular carcinoma.Results The preoperative NLR,PLR,and SⅡ levels in the study group were significantly higher than those in the control group(6.92±2.16,167.90±33.21,and 432.52±56.22 vs.3.13±0.84,110.11±24.26,and 326.40±20.35,respectively;t=18.310,15.465,19.898,P＜0.001).The results of multivariate logistic regression analysis showed that elevated NLR(OR=1.822,95％CI:1.295-2.563),PLR(OR=1.037,95％CI:1.015-1.060),and SⅡ(OR=1.007,95％CI:1.002-1.012)levels were risk factors for poor prognosis of hepatitis B-related hepatocellular carcinoma(P＜0.05).The ROC curve results showed that the areas un-der the curve(AUC)for predicting poor prognosis of hepatitis B-related hepatocellular carcinoma were 0.852,0.862,0.813,and 0.904 for NLR,PLR,SⅡ,and their combination,respectively(P＜0.001).The sensitivity for NLR,PLR,SⅡ,and their combination was 80.95％,85.71％,74.16％,and 82.10％,and the specificity was 77.94％,77.94％,77.94％,and 95.59％,respectively.Conclusion Elevated NLR,PLR,and SⅡ are risk factors for poor prognosis of hepa-titis B-related hepatocellular carcinoma.The individual and combined detection of NLR,PLR,and SⅡ in these patients can help predict prognosis.
基金项目
河南省医学科技攻关计划(LHGJ20200517)
河南省高等学校重点科研项目(23A320037)
万方数据