NLR与PCT对直肠癌术后吻合口漏的早期诊断价值

Value of NLR and PCT in the Early Diagnosis of Anastomotic Leakage after Resection of Rectal Cancer

目的分析中性粒细胞淋巴细胞计数比值(neutrophil to lymphocyte ratio,NLR)与降钙素原(procalcitonin,PCT)在早期诊断直肠癌术后吻合口漏(anastomotic leakage,AL)的价值,为临床工作提供参考依据。方法以2016年11月～2017年11月220例于西南医科大学附属医院胃肠外科住院的直肠癌患者为纳入对象,将其分为两组,其中术后未发生AL患者205例(无AL组),发生AL(AL组)的患者15例,分别在术前、术后第1～7天检测外周血NLR、PCT水平,运用受试者工作特性曲线(ROC曲线)评价NLR、PCT在早期诊断直肠癌术后AL方面的价值。结果 220例患者中,15例患者术后发生AL(发生率为6. 818%),两组患者NLR值水平在术后第4天差异有统计学意义(P <0. 05),第5、6、7天差异有统计学意义(P <0. 01),行ROC曲线分析发现术后第6～7天NLR的AUC值> 0. 800,且在术后第7天出现最大值(AUC=0. 848);两组患者PCT值在术后第2、3天差异有统计学意义(P <0. 05),第4、5、6、7天差异有统计学意义(P <0. 01),行ROC曲线研究时发现术后第4、5、6、7天PCT的AUC值> 0. 800,且在术后第5天达到最大值(AUC=0. 903)。结论 NLR、PCT均可用于早期诊断直肠癌Dixon术后AL,且PCT比NLR更具有诊断价值。

Objective To analyze the value of neutrophil to lymphocyte ratio （NLR） and procalcitonin （PCT） in the early diagnosis of anastomotic leakage after rectal cancer, and to provide a reference for clinical research. Methods Totally 220 patients with rectal cancer hospitalized in gastroenterology department of Affiliated Hospital of Southwest Medical University from November 2016 to November 2017 were enrolled and divided into two groups. Among them, 205 patients without AL （no AL group）, AL （AL group） in 15 patients, respectively, preoperative and postoperative 1 to 7 days detection of peripheral blood NLR, PCT levels.NLR was evaluated by receiver operating characteristic curve （ROC curve）. The value of AL in the diagnosis of postoperative rectal cancer. P 〈0.05 means that the difference was statistically significant, and P 〈0.01 means the difference was statistically significant. Results Of the 220 patients, 15 patients had AL after operation （the incidence was 6.818%）. The NLR level of the two groups had statistical difference at fourth days after operation （ P 〈0.05）, and there was significant difference between fifth, sixth, seventh days （ P 〈0.01）. The ROC curve analysis showed that the AUC value of NLR from sixth to 7 days after operation was more than 0.800, and the maximum value was found at seventh days after the operation （AUC=0.848）. PCT of two groups on the second, third day after operation had statistical differences （ P 〈0.05）, fourth, fifth, sixth, seventh days have significant difference （ P 〈0.01）. ROC curve study found AUC value of fourth, fifth, sixth, seventh days after the operation of PCT is greater than 0.800, and fifth days after the operation reaches the maximum value （AUC=0.903）. Conclusion Both NLR and PCT can be used for early diagnosis of anastomotic leakage after Dixon rectal cancer, and PCT is more diagnostic than NLR.