摘要
目的探讨术前中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-lymphocyte ratio,PLR)、单核细胞与淋巴细胞比值(monocyte-lymphocyte ratio,MLR)、预后营养指数(prognostic nutritional index,PNI)等血液学指标在男、女性脑胶质瘤患者预后评估中的作用。方法行根治性切除术脑胶质瘤患者214例,男120例,女94例。比较男、女性患者术前NLR、PLR、MLR、PNI及白球比(albumin-globulin ratio,AGR)差异;绘制ROC曲线,确定NLR、PLR、MLR诊断脑胶质瘤的最佳截断值,并将214例患者进行分组,其中低NLR组(NLR<4.05)162例、高NLR组(NLR≥4.05)52例,低PNI组(PNI<50.15)162例、高PNI组(PNI≥50.15)52例,低MLR组(MLR<0.26)147例、高MLR组(MLR≥0.26)67例,比较男、女性不同NLR、MLR、PNI分组患者生存期,多因素Cox回归分析影响男、女性脑胶质瘤患者预后的因素。结果男性脑胶质瘤患者术前AGR(1.62±0.26)高于女性患者(1.48±0.25)(P<0.05),NLR(3.87±1.01)、PLR(141.23±80.37)、MLR(0.26±0.16)、PNI(49.05±5.68)与女性患者(4.04±3.65、163.49±114.75、0.24±0.18、48.76±5.10)比较差异均无统计学意义(P>0.05);截至末次随访,失访82例,死亡91例(男42例,女49例),生存41例;男性患者中,低NLR组、低MLR组总生存期[(28.36±2.04)、(28.33±2.29)个月]与高NLR组[(17.84±2.49)个月]、高MLR组[(20.09±1.92)个月]比较差异均无统计学意义(P>0.05),低PNI组总生存期[(22.26±2.20)个月]较高PNI组[(32.44±2.72)个月]短(P<0.05);女性患者中,低NLR组、低MLR组总生存期[(31.60±2.49)、(32.53±2.64)个月]较高NLR组[(12.64±2.52)个月]、高MLR组[(15.52±2.30)个月]长(P<0.05),低PNI组总生存期[(22.74±2.84)个月]较高PNI组[(31.49±2.99)个月]短(P<0.05);多因素Cox回归分析结果显示,高MLR(HR=13.014,95%CI:2.180~77.702,P=0.005)是女性脑胶质瘤患者预后的危险因素。结论术前PNI可能与男性脑胶质瘤患者生存期有关,术前NLR、MLR、PNI可能与女性脑胶质瘤患者生存期有关,其中术前MLR≥0.26是女性脑胶质瘤患者预后的独立危险因素。
Objective To investigate the roles of preoperative neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),monocyte-lymphocyte ratio(MLR)and prognostic nutritional index(PNI)in evaluating the prognosis of male and female patients with gliomas.Methods A total of 214 patients with gliomas undergoing radical resection included 120 males and 94 females.The levels of preoperative NLR,PLR,MLR,PNI and albumin-globulin ratio(AGR)were compared between male patients and female patients.ROC was used to obtain the optimal cut-off value of NLR,PLR and MLR for diagnosing gliomas.And these 214 patients were redivided into 162 patients with NLR<4.05(low-NLR group)and 52 patients with NLR≥4.05(high-NLR group),162 patients with PNI<50.15(low-PNI group)and 52 patients with PNI≥50.15(high-PNI group),as well as 147 patients with MLR<0.26(low-MLR group)and 67 patients with MLR≥0.26(high-MLR).The survival time of male and female patients with different NLR,MLR and PNI levels was compared.Multivariate Cox regression was used to analyze the prognostic factors for gliomas.Results The preoperative AGR was significantly higher in male patients(1.62±0.26)than that in female patients(1.48±0.25)(P<0.05),and there were no significant differences in NLR(3.87±1.01 vs.4.04±3.65),PLR(141.23±80.37 vs.163.49±114.75),MLR(0.26±0.16 vs.0.24±0.18)and PNI(49.05±5.68 vs.48.76±5.10)between male and female patients(P>0.05).Till the final follow-up,82 patients were lost,91 died(42 males,49 females),and 41 survived.The survival was significantly shorter in low-PNI group((22.26±2.20)months)than that in high-PNI group((32.44±2.72)months)(P<0.05),and showed no significant difference between low-and high-NLR groups((28.36±2.04)months vs.(17.84±2.49)months)and low-and high-MLR groups((28.33±2.29)months vs.(20.09±1.92)months)in males patients(P>0.05).The survival time was significantly longer in low-NLR group((31.60±2.49)months)and low-MLR group((32.53±2.64)months)than that in high-NLR group((12.64±2.52)months)and high-MLR group((15.52±2.30)months)(P<0.05),and was shorter in low-PNI group((22.74±2.84)months)than that in high-PNI group((31.49±2.99)months)in female patients(P<0.05).The multivariate Cox regression analysis showed that high MLR(HR=13.014,95%CI:2.180-77.702,P=0.005)was the risk factor for the prognosis of female patients with gliomas.Conclusion The preoperative level of PNI might be correlated with the survival time of male patients with gliomas.The preoperative levels of NLR,MLR and PNI might be correlated with the survival time of female patients with gliomas,and preoperative MLR≥0.26 is an independent risk factor for the prognosis of female patients with glioma.
作者
晁储瑞
赵伟峰
刘慧敏
王怡君
郭爱叶
王朝杰
CHAO Churui;ZHAO Weifeng;LIU Huimin;WANG Yijun;GUO Aiye;WANG Chaojie(Department of Oncology,Henan University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Clinical Laboratory,Henan Provincial People’s Hospital,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2019年第11期1105-1109,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技厅科技攻关项目(172102310064)
河南省卫生健康委员会科技攻关项目(201702195)
