弥漫性大B细胞淋巴瘤患者外周血NLR、PLR以及LDH的水平及其临床意义

The level and clinical significance of NLR,PLR and LDH in peripheral blood of patients with diffuse large B-cell lymphoma

目的:研究弥漫性大B细胞淋巴瘤患者外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及乳酸脱氢酶(LDH)与健康人的差异、不同分期之间的差异,以及三者联合检测的诊断价值。方法:收集我院血液科2018年10月至2020年10月收治的81例DLBCL患者作为实验组,同期85例健康体检者作为对照组,根据Ann Arbor分期标准将淋巴瘤组患者分为Ⅰ-Ⅱ期(n=27)、Ⅲ-Ⅳ期(n=54),测定外周血NLR、PLR及LDH水平,对比两组及不同分期之间是否存在差异;建立受试者工作特征(ROC)曲线,通过分析曲线下面积(AUC),对比NLR、PLR、LDH以及三者联合对DLBCL的诊断价值。结果:淋巴瘤组81例,NLR、PLR、LDH分别为(3.65±2.55)、(207.73±11.01)、(371.79±63.56)ng/mL,均显著高于对照组(1.96±0.62,P<0.05)、(127.88±41.05,P<0.05)、(151.99±43.72,P<0.05)ng/mL,两组之间差异有统计学意义。与Ⅰ-Ⅱ期患者的NLR(3.00±1.63)、PLR(172.99±61.87)、LDH(279.15±19.12)ng/mL水平对比,Ⅲ-Ⅳ期患者NLR(3.98±2.86)、PLR(225.10±25.71)、LDH(418.11±23.83)ng/mL的水平均显著升高,差异有统计学意义(P=0.045,P=0.014,P=0.011)。ROC曲线:NLR以2.44为临界值时对DLBCL的诊断灵敏度、特异性、准确度分别为69.1%、78.8%、74.1%,PLR以168.64为临界值时对DLBCL的诊断灵敏度、特异性、准确度分别为61.7%、87.1%、74.7%,LDH以186.50 ng/mL为临界值时对DLBCL的诊断灵敏度、特异性、准确度分别为75.3%、94.1%、84.9%,三者联合时分别为80.2%、91.8%、85.5%。四种方法特异度的差异有统计学意义(P=0.022),灵敏度、准确度的差异无统计学意义(P=0.054,P=0.133)。两两比较发现,三者联合的灵敏度高于PLR单独检测(P=0.009),特异性高于NLR单独检测(P=0.027)。NLR、PLR、LDH的曲线下面积分别为0.78、0.788、0.866,三者联合为0.916,显著高于三者单独检测(P<0.05)。结论:与健康人对比,NLR、PLR及LDH在弥漫性大B细胞淋巴瘤患者中显著升高,且与分期有关,三者联合检测可以显著提高对DLBCL的诊断价值。

Objective:To explore the differences between neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and lactate dehydrogenase(LDH)in patients with diffuse large B-cell lymphoma(DLBCL)and healthy people,the difference between different stages,and the diagnostic value of the three combined detection.Methods:81 DLBCL patients,in department of hematology of our hospital from October 2018 to October 2020 were collected as experimental group,and 85 healthy physical examination subjects during the same period as control group.According to the Ann Arbor staging standard,the lymphoma group patients were divided into stageⅠ-Ⅱ(n=27),stageⅢ-Ⅳ(n=54).Measure the level of peripheral blood NLR,PLR and LDH,compare the above indicators between the two groups and different stages.Establish the ROC curve,analyze the diagnostic value of the above indicators for DLBCL.Results:In lymphoma group,NLR,PLR,LDH were(3.65±2.55),(207.73±11.01),(371.79±63.56)ng/mL,significantly higher than the control group(1.96±0.62,P<0.05),(127.88±41.05,P<0.05),(151.99±43.72,P<0.05)ng/mL.The difference between the two groups was statistically significant.Compared with the levels of NLR(3.00±1.63),PLR(172.99±61.87),and LDH(279.15±19.12)ng/mL in patients fromⅠtoⅡ,NLR(3.98±2.86),PLR(225.10±25.71),LDH(418.11±23.83)ng/mL was significantly increased in theⅢtoⅣ,and the difference was statistically significant(P=0.045,P=0.014,P=0.011).ROC curve showed the sensitivity,specificity and accuracy of DLBCL diagnosis when NLR was 2.44 as the cut-off value were 69.1%,78.8%,and 74.1%.The sensitivity,specificity and accuracy of DLBCL diagnosis when PLR was 168.64 as the cut-off value were 61.7%,87.1%,and 74.7%.The sensitivity,specificity and accuracy of DLBCL diagnosis when the LDH was 186.50 ng/mL as the cutoff value were 75.3%,94.1%,and 84.9%.When the three were combined,the sensitivity,specificity and accuracy was 80.2%,91.8%,and 85.5%.The difference in specificity of the four methods was statistically significant(P=0.022),and the difference in sensitivity and accuracy was not statistically significant(P=0.054,P=0.133).The sensitivity of the combination of the three was higher than that of PLR alone(P=0.009),and the specificity was higher than that of NLR alone(P=0.027).The area under the curve of NLR,PLR,and LDH were 0.78,0.788,0.866,respectively,and the combined value of the three was 0.916,which was significantly higher than that of the three alone(P<0.05).Conclusion:Compared with healthy people,NLR,PLR and LDH are significantly increased in patients with diffuse large B-cell lymphoma,and are related to the stage.The combined detection of the three can significantly improve the diagnostic value of DLBCL.