肺癌患者血常规指标特征分析

Analysis of blood routine test in lung cancer patients

目的识别肺癌与健康对照、肺癌不同亚组间的血常规指标差异,提高对肺癌预后的早期判断,为对肺癌患者进行危险分层与分类管理提供依据。方法纳入2008年12月—2013年12月1227例确诊为肺癌的患者及按性别、年龄1∶2匹配后的2454例健康对照,收集肺癌患者首次确诊肺癌入院时的血常规资料,比较肺癌患者与健康对照的血常规指标,并按性别、年龄进行分层分析;比较不同病理类型、分期及预后的肺癌患者血常规指标,对肺癌患者进行Cox回归生存分析。正态分布资料采用均数±标准差表示,非正态分布资料采用中位数(下四分位数,上四分位数)表示。结果肺癌患者血小板计数[(206.84±80.47)vs.(175.27±55.74)×10^9/L]、白细胞计数[(7.04±2.29)vs.(6.08±1.40)×10^9/L]、中性粒细胞绝对值[(4.90±2.08)vs.(3.61±1.07)×10^9/L]、单核细胞绝对值[0.42(0.30,0.54)vs.0.33(0.26,0.42)×10^9/L]、嗜酸性粒细胞绝对值[0.14(0.07,0.24)vs.0.12(0.07,0.19)×10^9/L]、中性粒细胞-淋巴细胞比值(3.91±2.82 vs.2.03±0.89)及血小板-淋巴细胞比值(160.35±96.06 vs.96.93±38.02)较健康对照升高,红细胞计数[(4.41±0.58)vs.(4.85±0.51)×1012/L]及淋巴细胞绝对值[(1.49±0.60)vs.(1.93±0.59)×10^9/L]则较健康对照降低,差异均有统计学意义(P<0.05)。不同病理类型、分期及预后的肺癌患者血小板、红细胞、白细胞、中性粒细胞、单核细胞绝对值差异有统计学意义(P<0.05);中性粒细胞-淋巴细胞比值及血小板-淋巴细胞比值在鳞状细胞癌患者高于其他病理类型患者,在晚期肺癌患者高于早期患者,在死亡肺癌患者高于存活患者(P<0.05)。中性粒细胞-淋巴细胞比值是影响肺癌预后的独立因素[风险比=1.077,95%置信区间(1.051,1.103),P<0.001]。结论肺癌患者血常规炎症指标高于健康对照,预示肺癌与慢性炎症有关;不同病理类型、分期、预后的肺癌患者血常规炎症指标存在差异,反映着肺癌异质性及复杂性;高中性粒细胞-淋巴细胞比值预示肺癌不良预后。

Objective To identify differences in blood routine indicators between lung cancer patients and healthy controls,and between different subgroups of lung cancer patients,so as to improve the early detection of lung cancer prognosis,and provide a basis for risk stratification and prognostic judgment for patients with lung cancer.Methods This study enrolled 1227 patients pathologically diagnosed with lung cancer from December 2008 to December 2013 and 2454 healthy controls 1∶2 matched by sex and age.The blood routine data of lung cancer patients were collected when they were first diagnosed with lung cancer.Gender and age stratified analysis of blood routine indicators between lung cancer patients and controls were conducted.Comparisons of blood routine indicators among lung cancer patients with different pathological types,stages,and prognosis were performed,followed by Cox regression survival analysis.Normally distributed quantitative variables were presented as mean±standard deviation and nonnormally distributed quantitative variables as medium(lower quartile,upper quartile).Results Compared to healthy controls,the counts of platelet[(206.84±80.47)vs.(175.27±55.74)×10^9/L],white blood cells[(7.04±2.29)vs.(6.08±1.40)×10^9/L],neutrophil[(4.90±2.08)vs.(3.61±1.07)×10^9/L],monocyte[0.42(0.30,0.54)vs.0.33(0.26,0.42)×10^9/L],and eosinophil[0.14(0.07,0.24)vs.0.12(0.07,0.19)×10^9/L],as the well as neutrophil-lymphocytes ratio(3.91±2.82 vs.2.03±0.89)and platelet-lymphocyte ratio(160.35±96.06 vs.96.93±38.02)in lung cancer patients increased significantly,while the counts of red blood cells[(4.41±0.58)vs.(4.85±0.51)×1012/L]and lymphocyte[(1.49±0.60)vs.(1.93±0.59)×10^9/L]in lung cancer patients decreased,and the differences were statistically significant(P<0.05).The counts of platelet,red blood cells,white blood cells,neutrophil,and monocyte differed among patients with different pathological types,tumor stages,and prognosis(P<0.05).Neutrophil-lymphocytes ratio and platelet-lymphocyte ratio were higher in squamous cell carcinoma patients than those in other pathological patients,higher in advanced lung cancer patients than those in early stage patients,and higher in dead lung cancer patients than those in survival patients(P<0.05).Neutrophillymphocyte ratio was an independent factor affecting the prognosis of lung cancer[hazard ratio=1.077,95%confidence interval(1.051,1.103),P<0.001].Conclusions The inflammatory index of blood routine indicators are higher in lung cancer patients than those in healthy controls,which indicates that lung cancer is closely related to chronic inflammation.There are significant differences in blood routine inflammation index among lung cancer patients with different pathological types,stages,and prognosis,which reflects the heterogeneity and complexity of lung cancer.Neutrophillymphocytes ratio inverse correlates with the prognosis of lung cancer.