NLR、PLR及其变化趋势对直肠癌术后吻合口漏预测价值

Value of NLR,PLR and their changes in predicting occurrence of anastomotic leakage after surgery in patients with rectal cancer

目的:探索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(Plateletlymphocyte ratio,PLR)及其术后变化对直肠癌患者术后吻合口漏(Anastomotic leakage,AL)的预测价值。方法:纳入187例2015年3月至2016年3月西南医科大学附属医院胃肠外科直肠癌患者。选取术前中性粒细胞与淋巴细胞比值(术前NLR)、血小板淋巴细胞比值(术前PLR)、手术前后中性粒细胞与淋巴细胞比值的变化值(术后NLR/术前NLR)及手术前后血小板、淋巴细胞比值的变化值(术后PLR/术前PLR)作为观察指标,同时观察危险因素,包括年龄、性别、肿瘤病理分期、淋巴分期、分化程度、肿瘤下极距肛门的距离。单因素分析采用χ~2检验或Fisher确切概率法,多因素分析采用Logistic回归方程。结果:单因素分析显示术前NLR(Fisher值=7.242)、术前PLR(χ~2=6.787)、手术前后NLR(χ~2=15.656)、PLR(χ~2=9.298)变化趋势、年龄(χ~2=4.813)和肿瘤下极距肛缘的距离(χ~2=5.951)与AL发生相关(P<0.05)。而性别(χ~2=0.001)、肿瘤病理分期(Fisher值=2.107)、淋巴分期(Fisher值=1.298)、分化程度(Fisher值=2.206)均不是影响术后AL发生的危险因素(P>0.05)。多因素分析显示术前NLR值(OR=1.647,P=0.000)、手术前后NLR变化值(OR=1.880,P=0.000)和肿瘤下极距肛缘的距离(OR=4.364,P=0.048)与AL发生相关。结论:术前NLR、手术前后NLR的变化值以及肿瘤下极距肛缘的距离是直肠癌患者术后AL的独立危险因素。

Objective： To explore the value of preoperative neutrophil-lymphocyte ratio （ NLR） , preoperative platelet- lymphocyte ratio （PLR）,changes between pre and postoperative neutrophil-lymphocyte ratio（postopemtive NLR/preopemtive NLR） and changes between pre and postoperative platelet-lymphocyte ratio （ postoperative PLR/preoperative PLR） in predicting the occurrence of anastomotic leakage after surgery in patients of rectal cancer. Methods： 187 rectal cancer patients in the Gastrointestinal Surger^^ Department in the First Affiliated Hospital of Southwestern Medical University during March,2015-March,2016 were included in our study. Preoperative NLR,preoperative PLR,changes between pre and postoperative NLR and changes between pre andpostoperative PLR were obser^^ ed. At the same time we included age, gender,pathological staging, stage of lymph node metastasis,tumor differentiation,distance between tumor and anus in our study.;字2 test or Fisher＇s exact value was used in the univariate analysis,while Logistic Regression Analysis was used in the multivariate analysis. Results ： The univariate analysis showed that preoperative NLR （Fisher＇s exact value = 7. 242 ）,preoperative PLR （字2 = 6. 787） , changes between pre and postoperative NLR （ x~ = 15. 656 ） , PLR （ 字2 = 9. 298）,age （字2 =4. 813） and distance between tumor and anus （ x~ = 5. 951） were related to anastomotic leakage（ P〈0.05）. Other risk factors such as, gender（;字2 = 0. 001）,pathological staging （ Fisher＇s exact value = 2. 107 ） , stage of lymph node metastasis （Fisher＇s exact value = 1. 298）, tumor differentiation （ Fisher＇s exact value = 2. 206） ,and were not associated with anastomotic leakage （P〉0. 05）. Multivariate analysis showed that the preoperative NLR（0R= 1. 647, P = 0.000） , change between pre and postoperative NLR （ 0R= 1. 880, P = 0. 000） and distance between tumor and anus （ OR = 4. 364, P = 0. 048 ） were associated with anastomotic- leakage. Conclusion： preoperative NLR,change between pre and postoperative NLR and distance between tumor and anus are independent risk factors for anastomotic leakage after rectal anterior resection.