中性粒细胞与淋巴细胞比值对前列腺癌诊断的临床价值及与危险分级的关系

The clinical value of neutrophil-to-lymphocytes ratio in the diagnosis of prostate cancer and its relationship with risk grade

目的分析中性粒细胞与淋巴细胞比值(NLR)单独或联合前列腺特异性抗原(PSA)和年龄预测前列腺癌(PCa)的临床价值及其与危险分级的关系.方法收集2016年6月至2020年6月在新乡医学院第三附属医院和第一附属医院就诊的1205例患者,根据诊断结果将患者分为对照组(1060例)和PCa组(145例).根据欧洲泌尿外科协会指南再将PCa患者分为低(48例)、中(62例)、高(35例)危组.比较患者的一般资料,采用单因素和多因素logistic回归分析影响PCa的危险因素,采用受试者工作特征(ROC)曲线评估NLR、PSA和年龄单独检测预测PCa的临床价值,并建立联合预测模型方程.比较不同PCa危险分级组间的NLR水平.结果PCa组的年龄、PSA、空腹血糖(FBG)、NLR和单核细胞与淋巴细胞比值(MLR)高于对照组,淋巴细胞计数低于对照组,差异均有统计学意义(均P<0.05).单因素logistic回归分析结果显示,年龄、PSA、淋巴细胞计数、血红蛋白、FBG和NLR与PCa均有相关性(均P<0.05).多因素logistic回归分析结果显示,年龄、PSA和NLR为影响PCa的独立危险因素(均P<0.05).PSA和NLR预测PCa的临床价值均高于年龄预测PCa的价值(Z=8.604、9.204,均P<0.001).NLR、PSA和年龄联合检测建立的ROC曲线下面积为0.905,灵敏度和特异度为82.5%和80.7%.低危组、中危组和高危组的NLR水平分别为(2.05±0.26)、(2.36±0.34)和(2.75±0.61),三组差异有统计学意义(F=32.021,P<0.001),且高危组的NLR水平均高于中危组和低危组(q=11.132、6.494,均P<0.001),中危组的NLR水平高于低危组(q=5.709,P<0.001).结论NLR为PCa的独立危险因素,与患者的危险度分级有关,与PSA和年龄联合检测可有效预测PCa.

Objective To detect neutrophil-to-lymphocyte ratio(NLR)alone or in combination with prostate specific antigen(PSA)and age predicts the clinical value of prostate cancer(PCa)and its relationship with risk grade.Methods From June 2016 to June 2020,1205 patients who came to the department of urology at the third affiliated hospital of Xinxiang medical college and the first affiliated hospital of Xinxiang medical college were collected.The patients were divided into control group(1060 cases)and PCa group(145 cases),PCA patients were divided into low,medium and high risk groups according to the guidelines of the European Urological Association.The general clinical data of the two groups of patients were compared,single-factor and multi-factor logistic regression analysis of risk factors affecting PCa.Receiver operating characteristic(ROC)curves were used to evaluate the clinical value of NLR,PSA and age alone in predicting PCa,and a combined prediction model equation was established.NLR levels among different PCa risk grades were compared.Results Age,PSA,fasting blood glucose(FBG),NLR and monocyte-to-lymphocyte ratio(MLR)and the PCa group were higher than those in the control group,and lymphocyte counts were lower than those in the control group,the difference was statistically significant(all P<0.05).Univariate logistic regression analysis showed that age,PSA,lymphocyte count,hemoglobin,FBG and NLR were associated with PCa(all P<0.05).Multivariate logistic regression analysis showed that age,PSA and NLR were independent risk factors for PCa(P<0.05).The clinical value of PSA and NLR in predicting PCa was higher than that of age(Z=8.604,9.204,all P<0.001).The ROC curve was established by the combined detection of NLR,PSA and age,the area under curve was 0.905,and the sensitivity and specificity were 82.5%and 80.7%.The NLR levels in the low-risk group,intermediate-risk group and high-risk group were(2.05±0.26),(2.36±0.34)and(2.75±0.61),respectively,and there was a significant difference among the three groups(F=32.021,all P<0.001),and the NLR level in the high-risk group was higher than that in the intermediate-risk group and the low-risk group(g=11.132,6.494,all P<0.001),and the NLR level in the intermediate-risk group was higher than that in the low-risk group(q=5.709,P<0.001).Conclusions NLR is an independent risk factor for PCa and is related to the risk classification of patients.Combined detection with PSA and age can effectively predict PCa.