衰弱及血常规指标对肿瘤病人发生免疫相关不良反应的预测价值研究

Study on the predictive value of frailty and blood routine indexes in immune-related adverse reactions of tumor patients

目的:探讨衰弱及血常规指标对肿瘤病人发生免疫相关不良反应的预测价值。方法:收集2020年1月—2021年7月在河南省人民医院肿瘤中心接受免疫治疗的152例肿瘤病人的病例资料,根据《ESMO免疫治疗的毒性管理指南解读》,将病人分为发生免疫相关不良反应组与未发生免疫相关不良反应组。采用独立样本t检验及χ^(2)检验分析两组病人衰弱分数和血常规等实验室检查指标的差异;采用Logistic回归分析影响病人发生免疫不良反应的独立危险因素;采用ROC曲线分析独立危险因素对免疫相关不良反应的预测价值。结果:单因素分析结果显示,衰弱、中性粒细胞计数、嗜碱性粒细胞计数、C反应蛋白、中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)是肿瘤病人免疫相关不良反应发生的影响因素(P<0.05)。二元Logistic回归分析结果显示,衰弱、PLR、NLR为肿瘤病人发生免疫相关不良反应的独立危险因素(P<0.05)。ROC曲线分析显示,衰弱得分、NLR、PLR曲线下面积分别为80.40%、72.30%、68.70%。结论:衰弱得分、NLR、PLR可作为肿瘤病人发生免疫相关不良反应发生的预测因素,且具有较好的敏感性与特异性。

Objective:To explore the predictive value of frailty and blood routine indicators in immune-related adverse reactions of tumor patients.Methods:The clinical data of 152 tumor patients who received immunotherapy in the cancer center of Henan Provincial People′s Hospital from January 2020 to July 2021 were collected.According to "interpretation of toxicity management guidelines for ESMO immunotherapy",patients were divided into immune-related adverse reactions group and non-immune-related adverse reactions group.Independent sample T test and test were used to analyze the difference of frailty score and blood routine indicators test between the two groups.Logistic regression analysis was used to analyze the independent risk factors of adverse immune reaction.ROC curve was used to analyze the predictive value of independent risk factors for immune-related adverse reactions.Results:Univariate analysis showed that frailty, neutrophil count, basophil count, C-reactive protein, neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte ratio(PLR) were the influential factors for the occurrence of immune-related adverse reactions in tumor patients(P<0.05).Binary Logistic regression analysis showed that frailty, PLR and NLR were independent risk factors for immune-related adverse reactions in tumor patients(P<0.05).ROC curve analysis showed that frailty score, NLR and PLR areas under the curve were 80.40%,72.30% and 68.70%,respectively.Conclusion:Frailty score, NLR and PLR can be used as predictors of immune-related adverse reactions in tumor patients with good sensitivity and specificity.