初诊时中性粒细胞与淋巴细胞比值对髓母细胞瘤患儿生存的影响

Effect of neutrophil-lymphocyte ratio at the initial visit on the survival of children with newly diagnosed medulloblastoma

目的探讨儿童髓母细胞瘤(MB)初诊时外周血中性粒细胞与淋巴细胞比值(NLR)对其生存的影响。方法采用病例对照研究, 入组2018年8月至2020年1月就诊于首都医科大学附属北京世纪坛医院儿科的61例初治MB患儿, 检测初治时患儿外周血常规、淋巴细胞亚群和免疫球蛋白定量, 根据外周血常规结果计算得出NLR, 以受试者工作特征(ROC)曲线确定最佳临界值, 将患儿分为高NLR组(≥2.07)21例和低NLR组(<2.07)40例。分析2组患儿无进展生存(PFS)和总体生存(OS)情况。若生存分析存在差异, 则进一步比较2组患儿临床特征、淋巴细胞亚群、免疫球蛋白定量的差异, 若存在差异, 则分析NLR与其相关性。生存分析采用Kaplan-Meier法, 组间比较采用Log-rank检验。组间比较采用χ^(2)分析、Mann-Whitney U检验和独立样本t检验。结果生存分析发现, 高NLR组MB复发率(38.1%比10.0%, χ^(2)=6.879, P=0.016)和死亡率(19.0%比0, χ^(2)=8.154, P=0.011)高于低NLR组。高NLR组患儿的PFS中位时间(12个月比19个月, χ^(2)=9.775, P=0.002)和OS中位时间(19个月比20个月, χ^(2)=8.432, P=0.004)短于低NLR组。2组患儿临床特征分布差异均无统计学意义(均P>0.05)。但高NLR组T淋巴细胞[(67.93±6.37)%比(73.38±8.08)%, t=2.886, df=48.865, P=0.006]、T辅助细胞(Th)[(30.86±5.53)%比(34.29±7.44)%, t=2.037, df=51.981, P=0.047]、T抑制细胞(Ts)[(27.39±5.50)%比(30.84±6.58)%, t=2.164, df=47.581, P=0.035]的百分比均低于低NLR组。NLR与T淋巴细胞(r=-0.303, P=0.018)、Ts(r=-0.260, P=0.043)存在负相关性。结论初治时NLR较高的MB患儿预后相对较差, 这种预后差异可能与T淋巴细胞、Ts等免疫细胞相关。

Objective To explore the effect of neutrophil-lymphocyte ratio(NLR)at the initial visit on the survival of children with newly diagnosed medulloblastoma(MB).Methods This was a case-control study involving 61 children with newly diagnosed MB at the Department of Pediatrics,Beijing Shijitan Hospital,Capital Medical University from August 2018 to January 2020.The blood cell counts,lymphocyte subsets and immunoglobulin in the periphe-ral blood were measured to calculate NLR at the initial visit.Based on the cut-off value determined by receiver opera-ting characteristic(ROC)curve,patients were divided into high NLR group(≥2.07,n=21)and low NLR group(<2.07,n=40).The progression-free survival(PFS)and overall survival(OS)between 2 groups were analyzed by the Kaplan-Meier method,followed by Log-rank test.The correlation between NLR at the initial visit with clinical characteristics,lymphocyte subsets and immunoglobulin of children with newly diagnosed MB was analyzed.Differences between groups were compared by the Chi-square test,Mann-Whitney U test and independent sample t test.Results The survival analysis showed that the relapse rate(38.1%vs.10.0%,χ^(2)=6.879,P=0.016)and mortality rate(19.0%vs.0,χ^(2)=8.154,P=0.011)were significantly higher in high NLR group than those of low NLR group.PFS(12 months vs.19 months,χ^(2)=9.775,P=0.002)and OS(19 months vs.20 months,χ^(2)=8.432,P=0.004)were significantly shorter in high NLR group than those of low NLR group.No significant differences in clinical characteristics were detected between groups(all P>0.05).Compared with low NLR group,the percentage of T lymphocyte[(67.93±6.37)%vs.(73.38±8.08)%,t=2.886,df=48.865,P=0.006],T helper cells(Th)[(30.86±5.53)%vs.(34.29±7.44)%,t=2.037,df=51.981,P=0.047],and T suppressor cells(Ts)[(27.39±5.50)%vs.(30.84±6.58)%,t=2.164,df=47.581,P=0.035]were significantly lower in high NLR group.Spearman correlation analysis showed a negative correlation between NLR and T lymphocyte count(r=-0.303,P=0.018),and Ts lymphocyte count(r=-0.260,P=0.043).Conclusions Children with newly diagnosed MB expressing a high level of NLR had a poor prognosis,which may be associated with T lymphocyte and Ts lymphocyte.