中性粒细胞和淋巴细胞VCS参数与NLR对肿瘤患者化疗后细菌感染辅助诊断价值

Auxiliary diagnostic value of neutrophil and lymphocyte VCS parameters and NLR on bacterial infection in post-chemotherapy cancer patients

目的化疗是治疗恶性肿瘤的重要方式之一,但化疗药物会抑制骨髓增生,长期治疗后,机体产生免疫抑制很容易感染。肿瘤患者合并病原菌感染是肿瘤患者的死亡原因之一,本研究回顾性分析探讨白细胞计数(white blood cell count,WBC)、中性粒细胞计数(neutrophil count,NC)、淋巴细胞计数、中性粒细胞和淋巴细胞VCS参数以及中性粒细胞和淋巴细胞计数比值(neutrophil and lymphocyte ratio,NLR)等指标对肿瘤患者化疗后发生细菌感染的辅助诊断价值。方法选取2015-03-01-2016-01-01山东大学附属山东省肿瘤医院接受化学治疗的305例肿瘤患者,根据细菌培养结果确诊为局部细菌感染的肿瘤患者190例(肿瘤感染组),未发生细菌感染的115例(肿瘤未感染组),同期健康体检者75名(健康对照组)。应用Beckman Coulter LH750血细胞分析仪进行血细胞分类计数检查,比较各项指标在三组中的差异,并采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析各项指标及其联合对肿瘤患者细菌感染的辅助诊断价值。结果 WBC、NC、中性粒细胞平均体积(mean neutrophil volume,MNV)、中性粒细胞平均传导值(mean neutrophil conductivity,MNC)、淋巴细胞平均光散射值(mean lymphocyte light scatter,MLS)、NLR在健康对照组、肿瘤未感染组以及肿瘤感染组中差异均有统计学意义,均P<0.05。通过ROC曲线分析各指标的诊断价值,各指标ROC曲线下面积(areas under curves,AUC)WBC为0.631,NC为0.654,MNV为0.639,MNC为0.632,MLS为0.717,NLR为0.708,其中MLS和NLR具有较高的辅助诊断价值。MLS临界值取69.700,灵敏度为73.20%,特异度为61.70%;NLR临界值取5.166,灵敏度为65.80%,特异度为69.60%。结论 MLS和NLR相比于WBC、NC等传统的炎症指标可以更好地辅助诊断肿瘤患者化疗后的细菌感染。

OBJECTIVE Chemotherapy is one of the important therapeutic methods of malignant tumors, but chemotherapeutic drugs can inhibit the growth of bone marrow.After long -term treatment, the body is easily infected because of immunosuppression.The pathogen infection is one of the cause of death in patients with tumor.Retrospective analysis was used to investigate leukocytes count, neutrophils count?lymphocytes count, neutrophils and lymphocytes VCS parameters and neutrophils and lymphocytes count ratio(NLR) of cancer patients who received chemotherapy,and evaluate their auxiliary diagnostic value of bacterial infection.METHODS Totally 305 cancer patients were recruited who received chemotherapy in Shandong Cancer Hospital from March 1,2015 to January 1,2016.According to the results of bacterial culture, 190 patients were diagnosed local bacterial infection, and 115 patients without bacterial infection, 75 healthy people.Blood cell differential counting was performed by Beckman Coulter LH75O blood cell analyzer,and the differences among the three groups were compared.The ROC curve was used to analyze the auxiliary diagnostic value of various indicators and the combination of these indicators for bacterial infection in cancer patients.RESULTS These parameters were significant differences in the healthy control group and tumor uninfected group, tumor infection group .The parameters including white blood cell count.neutrophil count,mean neutrophil volume( MNV),mean neutrophil conductivity( MNC),mean lymphocyte light scatter(MLS), Neutrophil-lymphocyte ratio(NLR).The diagnostic value of each indicator is analyzed by the receiver operating characteristic( ROC) curve.The areas under the ROC curve of white blood cell count was 0.631, NC was 0.654 , MNV was 0.639, MNC was 0.632, MLS was 0.717 and NLR was 0.708, respectively.MLS and NLR had high auxiliary diagnostic value.When the cutoff value of MLS was 69.700, the sensitivity was 73.20%, the specificity was 61.70%.The cutoff value of NLR was 5.166, the sensitivity was 65.80%, and the specificity was 69.60%.CONCLUSIONS Compared with traditional inflammatory markers such as white blood cell count and neutrophil count, MLS and NLR can be used to auxiliary diagnosis of bacterial infection after chemotherapy in cancer patients.