中性粒细胞/淋巴细胞、血小板/淋巴细胞和纤维蛋白原在结直肠癌中的预测作用

Predictive Effect of Neutrophil-to-lymphocyte Ratio,Platelet-to-lymphocyte Ratio and Fibrinogen on Colorectal Cancer

目的探讨外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)和纤维蛋白原(fibrinogen,FIB)在结直肠癌(colorectal cancer,CRC)中的预测作用。方法收集徐州医科大学附属医院2016年1月~2017年12月收治CRC患者459例,另外选取同期结直肠息肉患者203例及正常健康体检者214例,比较3组患者NLR、PLR、FIB与CEA水平,利用受试者工作特征(ROC)曲线分析NLR、PLR、FIB、CEA对CRC的诊断效力。利用Kruskal-Wallis检验及单因素方差分析NLR、PLR、FIB、CEA与CRC临床分期的关系。结果CRC组NLR、PLR、FIB、CEA均明显高于结肠息肉组和健康对照组(P<0.05),结直肠息肉组与健康对照组4种指标比较,差异均无统计学意义(P>0.05)。NLR、PLR、FIB、CEA诊断CRC的ROC曲线下面积(AUC)分别为:0.73、0.65、0.71、0.76。NLR、PLR、FIB、FIB均与CRC的分期有关,且与CEA、PLR、FIB比较,NLR显示出较早期的升高,在预测CRCⅠ期的ROC曲线下面积明显高于FLR、FIB、CEA曲线下面积,差异均有统计学意义(P<0.05)。结论外周血NLR、PLR、FIB升高对预测CRC具有一定的意义,NLR、PLR、FIB与CRC的临床分期相关,与CEA比较,NLR可能有助于更早期的预测CRC。

Objective To investigate the prediction effect of neutrophil-to-lymphocyte ratio (NLR),platelet-to-lymphocyte ratio (PLR) and fibrinogen (FIB) from peripheral blood in colorectal cancer.Methods Totally 459 cases of colorectal cancer in affiliated hospital of xuzhou medical university from January 2016 to December 2017 were collected,and 203 patients with same stage colorectal polyps and normal health examiners were selected.The levels of NLR,PLR,FIB and CEA in the 3 groups were compared.The effectiveness of NLR,PLR,FIB and CEA in the diagnosis of colorectal cancer was analyzed by ROC curve.The relationship between NLR,PLR,FIB,CEA and clinical staging of colorectal cancer was analyzed by Kruskal-Wallis test and single factor variance.Results NLR,PLR,FIB,CEA in colorectal cancer group was significantly higher than that in colon polyp group and healthy control group( P <0.05).There was no significant difference in four indexes between colorectal polyp group and healthy control group( P >0.05).The area under the ROC curve(AUC)for NLR,PLR,FIB,CEA diagnosis of colorectal cancer was 0.73,0.65,0.71 and 0.76 respectively.NLR,PLR,FIB and CEA were all related to CRC staging.Compared with CEA,PLR,FIB,NLR increased earlier,and the area under ROC curve was significantly higher than that under FLR,FIB,CEA curve in CRCⅠstage( P <0.05).Conclusion The increase of NLR,PLR and FIB in peripheral blood has a certain significance to the prediction of colorectal cancer.And the NLR,PLR and FIB are related to the clinical stages of colorectal cancer.Compared with CEA,high NLR may help to predict CRC earlier.