中性粒细胞/淋巴细胞比值联合C反应蛋白/白蛋白比值对直肠癌术后吻合口瘘的预测价值

Role of neutrophil to lymphocyte ratio combined with C reactive protein to albumin ratio in predicting postoperative anastomotic leakage in patients with rectal cancer

目的探讨中性粒细胞/淋巴细胞比值(NLR)联合C反应蛋白/白蛋白比值(CAR)对直肠癌术后吻合口瘘的预测价值。方法回顾性分析2016年8月至2020年8月就诊于中国人民解放军总医院第一医学中心普通外科的187例直肠癌患者的临床资料,根据吻合口瘘发生与否分为吻合口瘘组(27例)和非吻合口瘘组(160例),比较两组在不同时间点的NLR、CAR差异。采用ROC曲线评价NLR、CAR及两者联合对直肠癌患者术后发生吻合口瘘的预测价值。采用多因素logistic回归分析直肠癌患者术后发生吻合口瘘的独立危险因素。结果吻合口瘘组直肠癌患者的NLR在术后第3、5天均高于非吻合口瘘组(P<0.05、P<0.001),CAR在术后第5天高于非吻合口瘘组(P<0.001)。ROC曲线分析显示,术后第5天的NLR联合CAR预测直肠癌患者术后发生吻合口瘘的AUC值为0.814,术后第3、5天NLR和术后第5天CAR单独预测吻合口瘘的AUC值分别为0.652、0.746和0.789,其中术后第5天NLR联合CAR的AUC值与术后第3天NLR的AUC值差异有统计学意义(P=0.03)。多因素logistic回归分析显示,饮酒史、术后第3天NLR≥5.610、术后第5天NLR≥11.259和术后第5天CAR≥2.447是直肠癌患者术后发生吻合口瘘的独立危险因素(P均<0.05)。结论术后第5天NLR联合CAR、术后第3天NLR、术后第5天NLR和术后第5天CAR均对直肠癌术后吻合口瘘有预测价值,其中术后第5天NLR联合CAR预测效果最佳。

Objective To investigate the role of neutrophil to lymphocyte ratio(NLR)combined with C reactive protein to albumin ratio(CAR)in predicting postoperative anastomotic leakage(AL)in patients with rectal cancer.Methods The clinical data of 187 rectal cancer patients who underwent surgery in Department of General Surgery,the First Medical Center,Chinese PLA General Hospital from Aug.2016 to Aug.2020 were retrospectively analyzed.Patients were divided into AL group(27 cases)and non-AL group(160 cases),and NLR and CAR were compared between the 2 groups at different time points.Receiver operating characteristic(ROC)curve was used to evaluate the prediction value of NLR,CAR,and their combination for AL.Multivariate logistic regression analysis was used to explore the independent risk factors of postoperative AL in patients with rectal cancer.Results The NLR of rectal cancer patients in the AL group was significantly higher than that in the non-AL group on the 3^(rd)day and 5^(th)day after surgery(P<0.05 and P<0.001),and the CAR was significantly higher than that in the non-AL group on the 5^(th)day after surgery(P<0.001).ROC curve analysis showed that the area under curve(AUC)value of NLR combined with CAR on the 5^(th)day after surgery for predicting AL in rectal cancer patients was 0.814,and the AUC values of NLR on the 3^(rd)day and 5^(th)day after surgery and CAR on the 5^(th)day after surgery were 0.652,0.746 and 0.789,respectively.The AUC value of NLR combined with CAR on the 5^(th)day after surgery was significantly higher than that of NLR on the 3^(rd)day after surgery(P=0.03).Multivariate logistic regression analysis showed that drinking history,NLR≥5.610 on the 3^(rd)day after surgery,NLR≥11.259 on the 5^(th)day after surgery,and CAR≥2.447 on the 5^(th)day after surgery were independent risk factors for AL in rectal cancer patients(all P<0.05).Conclusion NLR combined with CAR on the 5^(th)day after surgery,NLR on the 3^(rd)day after surgery,NLR on the 5^(th)day after surgery and CAR on the 5^(th)day after surgery have predictive value for postoperative AL in rectal cancer patients,and NLR combined with CAR on the 5^(th)day after surgery has the best predictive effect.