NLR、RDW、MPV在乳腺癌疗效跟踪中的临床应用

The Clinical Application of NLR,RDW and MPV in the Therapeutic Effect of Breast Cancer Patients

目的探讨中性粒细胞绝对值与淋巴细胞绝对值比率（neutrophil lymphocyte ratio,NLR）、平均血小板体积（mean platelet volume,MPV）、红细胞体积分布宽度（red blood cell distribution width,RDW）在乳腺癌临床诊断、疗效跟踪及预后判断中的临床应用。方法回顾性分析2011年1月-2014年9月入住我院手术治疗的672例乳腺癌患者的血常规参数,收集其首次住院（手术前）、手术后、化疗前、化疗后、半年后复查不同时间血液,并采集了1 730名女性健康正常人的血液（正常组）,利用SIMENS ADVIA 2120全血细胞分析仪检测患者和健康正常人的NLR、MPV、RDW等指标。结合乳腺癌患者临床病理各项指标,分析其与NLR、MPV、RDW的相关性。结果 1不同病理学参数比较,MPV在年龄大于45岁组中较大（P〈0.05）;NLR在不同的组织学分型、分子分型和经典的T分期中均有统计学意义（P〈0.05）;而MPV在手术后复发和经典N分期中有统计学意义（P〈0.01）。2在免疫组化结果中,ER阴性组NLR和MPV均低于阳性组（P〈0.05）;Her-2阳性组NLR高于阴性或表达不详组（P〈0.05）。3正常组NLR明显低于乳腺癌术前组（P〈0.01）,而RDW则明显高于乳腺癌术前组（P〈0.01）。4NLR和MPV在手术前后、化疗前后和总治疗前后都有显著统计学意义（P〈0.01）,RDW在手术和总治疗后显著升高（P〈0.05和P〈0.01）。结论 NLR、MPV、RDW可作为乳腺癌临床病理诊断的参考指标,特别是这三个指标联用可用于乳腺癌手术和化疗效果的判断,有利于临床疗效跟踪。

Objective To study the application of NLR,RDW and MPV in the clinical diagnosis and therapeutic effect judgment in breast cancer. Methods Blood samples were collected from normal health persons（ n = 1 730） and breast cancer patients（ n = 672） at different time points before and after chemotherapy and surgery. The blood was detected by using SIMENS ADVIA 2120 whole blood cell analyzer with parameters of NLR,MPV,RDW,etc. The correlation of NLR,MPV,RDW and clinical pathological indicators of breast cancer was analyzed. Results Larger MPV was detected in older than 45 years old group（ P〈0. 05）. In different type organization credits or molecular classification and classic T staging,NLR had statistical significance（ P〈0. 05）. And MPV was statistically different in the recurrence after surgery and classical N staging column（ P〈0. 01）. In the ER negative group,NLR and MPV were less than positive group（ P〈0. 05）. In Her-2 positive group,NLR was higher than the negative group（ P〈0. 05）. NLR in normal group was obviously less than that in breast cancer pre- operation group（ P〈0. 01）,while RDW was significantly higher than that in the preoperative group（ P〈0. 01）. The values of NLR,MPV and RDW were significantly different between before and after surgery and treatment in breast cancer patients（ P〈0. 05）. Conclusion NLR,MPV and RDW can be used as the reference indexes for the clinical pathological diagnosis of breast cancer. The combination application of the three indicators may be used in therapeutic effect judgment of surgery and chemotherapy in breast cancer patients.