中性粒细胞/淋巴细胞比值在大肠癌癌变进展中的指示价值

The indicative value of neutrophils/lymphocyte ratio in the progress of colorectal cancer

目的 探讨中性粒细胞/淋巴细胞比值（Neutrophil to lymphocyte ratio,NLR）在大肠癌癌变进展中的指示价值。方法 选取安徽医科大学附属合肥医院收治大肠癌患者51例,腺瘤性息肉63例,炎性、增生性息肉75例以及正常对照组60例,同时随机选取其他消化系统恶性肿瘤48例和炎症性肠病患者21例;比较六组患者以及不同分期的大肠癌患者NLR、CEA、CA199水平差异;以ROC曲线的方法计算NLR升高的临界值和曲线下面积（AUC）,比较NLR、CEA和CA199在大肠癌筛查中的效率差异。结果 大肠癌组NLR水平明显高于腺瘤组、息肉组、正常对照组以及其他肿瘤和炎症性肠病组,差异具有统计学意义（P＜0.05）,其他肿瘤和炎症性肠病组NLR水平较高,但与腺瘤组、息肉组、正常对照组之间差异无统计学意义（P＞0.05）;Dukes A期、Dukes B期患者NLR水平低于Dukes C期、Dukes D期患者,差异具有统计学意义（P＜0.05）。NLR最佳临界值为2.73,AUC=0.727,具有较准确的诊断价值;NLR、CEA、CA199筛查大肠癌的灵敏度依次为：NLR＞CEA＞CA199,特异度CA199＞CEA＞NLR;三项指标联合检测时灵敏度和特异度可达81.62%和95.08%,高于单用和任意两指标联用时的筛查价值。结论 NLR升高对大肠癌患者体内高炎症反应状态有一定指示意义,在运用到大肠癌筛查时,其灵敏度优于传统肿瘤标记物,但特异性较差,故建议临床上与其他肿瘤标记物联合检查,提高筛查的准确性。

Objective To investigate the indicative value of Neutrophils/lymphocyte ratio in the progress of colorectal cancer.Methods Fifty one patients with colorectal cancer,63 cases with adenomatous polyps,75 cases with inflammatory and hyperplastic polyps,48 case of another digestive system tumors and 21case of inflammatory bowel diseases were enrolled in this study in the Affiliated Hefei Hospital of Anhui Medical University.We also chose sixty people as control group whom were conduct enteroscope as physical examination but didn＇t find any abnormal lesions and compared the date of NLR CEA and CA199 between six groups and different stages of colorectal cancer.The ROC curve was carried out to establish the cut off of NLR and the area under curve（AUC）.Furthermore,we compared the diagnostic efficiency of the three tumor markers.Results The level of NLR in patients with colorectal cancer was obviously higher than that of adenoma group,the polyp group,another digestive system tumor group,inflammatory bowel disease group and normal control group（P＜0.05）,despite the NLR value in another digestive system tumor and inflammatory bowel disease patients was elevated slightly,while there was no obvious differences between the another groups（P＞0.05）.The levels of NLR in patient with Dukes A and B stages were lower than Dukes C and D stages（P＜0.05）.The cut off of NLR was 2.73,AUC=0.727,suggesting an accurate diagnostic value.The diagnostic sensitivities of the three markers in order of NLR＞CEA＞CA199,and the specificities in order of CA199＞CEA＞NLR.Moreover,the diagnostic sensitivity and specificity of the combined detections of three markers were higher than either of screening respectively or two indicators of arbitrary joint.Conclusion The elevated value of NLR is corresponding to the high state of inflammation in colorectal cancer,when used NLR as a potential marker for diagnosis of colorectal cancer,the sensitivity is superior to the conventional tumor markers,but the specificity is not high,therefore,we should combined with the other tumor markers to improve the diagnostic accuracy.