中性粒细胞/淋巴细胞比值与预后营养指数早期预测直肠癌术后吻合口漏的价值

The value of neutrophil to lymphocyte ratio and prognostic nutritional index in early prediction of anastomotic leakage after rectal cancer surgery

目的:探索中性粒细胞/淋巴细胞比值(NLR)与预后营养指数(PNI)早期预测腹腔镜直肠癌根治术后吻合口漏(AL)的临床价值。方法:回顾性纳入2020年1月至2021年12月行腹腔镜直肠癌根治术的患者,收集患者一般资料,术前及术后第1天、第3天、第5天、第7天血清中性粒细胞计数、淋巴细胞计数、血清白蛋白水平,计算NLR与PNI。比较不同时点AL组与无AL组的NLR、PNI,根据受试者工作特征曲线评估PNI、NLR及两者联合检测对AL预测的准确性,并计算其灵敏度、特异度与截断值。结果:共入选89例患者,术后13例(14.6%)发生AL,其中A级AL 3例,B级8例,C级2例,诊断时间为术后4~10 d。两组患者性别、年龄、体质指数、手术时间、术中出血量、肿瘤最大直径、高血压、糖尿病、吸烟饮酒史等一般资料差异无统计学意义(P>0.05),但AL组术后住院时间长于无AL组(P<0.05),术后第3天、第5天血清NLR高于无AL组,PNI水平均低于无AL组。术后第3天PNI、NLR单独及两者联合检测预测AL的曲线下面积值分别为0.818、0.835、0.867,术后第5天为0.845、0.825、0.885,联合检测的曲线下面积值均大于单独检测,术后第3天联合检测灵敏度明显提高。结论:术后第3天NLR联合PNI对预测直肠癌根治术后AL的发生具有一定的临床价值。

Objective:To explore the clinical value of neutrophil to lymphocyte ratio(NLR)and prognostic nutrition index(PNI)in early prediction of anastomotic leakage(AL)after laparoscopic radical resection of rectal cancer.Methods:The patients who underwent laparoscopic radical resection of rectal cancer from Jan.2020 to Dec.2021 were enrolled retrospectively.The general data of the patients,the serum neutrophil count,lymphocyte count and serum albumin level before the operation,and on the 1st,3rd,5th and 7th day after the operation were collected,then the NLR and PNI were calculated.The levels of NLR and PNI were compared between the AL group and the non-AL group at different time points.According to receiver operating characteristic curve,the accuracy of PNI,NLR and their combined detection in predicting AL were evaluated,their sensitivity,specificity and cutoff value were calculated.R esults:A total of 89 patients were enrolled,and 13(14.6%)patients developed AL after the operation,including 3 cases of grade A AL,8 c ases of grade B and 2 cases of grade C.The diagnosis time was 4-10 d after the operation.There was no significant difference between the two groups in general data such as sex,age,body mass index,operative time,intraoperative blood loss,maximum tumor diameter,h ypertension,diabetes,smoking and drinking history(P>0.05),but the postoperative hospital stay in the AL group was longer than that in the non-AL group(P<0.05).On the 3rd and 5th postoperative day,the serum NLR levels in the AL group were higher than those in the non-AL group,and the PNI levels were lower than those in the non-AL group.The area under curve values of AL predicted by PNI,NLR alone and their combination on the 3rd postoperative day were 0.818,0.835 and 0.867,respectively.The area under curve values of AL predicted by PNI,NLR alone and their combination on the 5th postoperative day were 0.845,0.825 and 0.885,respectively.The area under curve values of combined detection were all higher than those of single detection.The sensitivity of combined detection was significantly increased on the third day after the operation.Conclusions:NLR combined with PNI on the third day after the operation has certain clinical value in the early prediction of AL occurrence after radical resection of rectal cancer.