基于四种炎症指标的肝癌合并微血管侵犯影响因素探讨

Analysis of influencing factors of microvascular invasion in patients with hepatocellular carcinoma based on four inflammatory markers

目的基于四种炎症指标探讨肝癌合并微血管侵犯(MVI)的影响因素。方法回顾性分析2017年1月至2020年12月郑州大学第一附属医院收治的行根治性切除术治疗的231例肝癌患者的临床资料,其中MVI阳性58例、MVI阴性173例。计算并比较两者中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、白蛋白与球蛋白比值(AGR)、系统免疫炎症指数(SII),用受试者工作特征(ROC)曲线确定NLR、PLR、LMR、AGR诊断MVI的最佳临界值,单因素和多因素分析肝癌患者合并MVI的影响因素。结果MVI阳性患者的NLR、PLR高于MVI阴性患者(t=3.922,P=0.048;t=4.551,P=0.034);而MVI阳性患者的LMR、AGR低于MVI阴性患者(t=5.450,P=0.021;t=20.684,P<0.001)。ROC曲线分析示肝癌患者NLR、PLR、LMR、AGR单独检测诊断MVI的最佳临界值分别为3.23、116.12、2.90、1.32,其曲线下面积(AUC)分别为0.712、0.698、0.686、0.678。在最佳临界值处对应的敏感性、特异性分别为:NLR为69.0%、73.4%,PLR为55.2%、84.4%,LMR为50.0%、87.3%,AGR为56.9%、78.6%。四种指标联合诊断时AUC为0.838,高于各单一指标。多因素分析结果提示,肿瘤直径、病理等级、NLR、PLR、LMR、AGR、AFP均是肝癌患者合并MVI的独立危险因素(OR=5.834,P=0.002;OR=3.442,P=0.005;OR=5.578,P=0.003;OR=4.421,P=0.002;OR=3.179,P=0.035;OR=3.520,P=0.004;OR=2.868,P=0.021)。结论NLR、PLR、LMR、AGR是肝癌合并MVI的危险因素,可对肝癌MVI的发生进行一定的预测,且四者联合时预测效果更优。

Objective To investigate the influencing factors of microvascular invasion(MVI)in hepatocellular carcinoma based on four inflammatory markers.Methods The clinical data of 231 patients with hepatocellular carcinoma in the First Affiliated Hospital of Zhengzhou University from Jan 2017 to Dec 2021 were retrospectively analyzed,including 58 patients with MVI positive and 173 patients with MVI negative.The neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),lymphocyte-monocyte ratio(LMR),albumin-globulin ratio(AGR),and systemic immune inflammatory index(SII)were calculated and compared between the two groups.The receiver operating characteristic(ROC)curve was used to determine the optimal critical values of NLR,PLR,LMR and AGR for the diagnosis of MVI,and the influencing factors of MVI in patients with hepatocellular carcinoma were analyzed by single factor and multiple factors.Results The NLR and PLR of MVI positive patients were significantly lower than those of MVI negative patients(t=3.922,P=0.048;t=4.551,P=0.034);the LMR and AGR of MVI positive patients were lower than those of MVI negative patients(t=5.450,P=0.021;t=20.684,P<0.001).ROC curve analysis showed that the optimal critical values of NLR,PLR,LMR and AGR in the diagnosis of MVI were 3.23,116.12,2.90 and 1.32,respectively.Area under the curve(AUC)were 0.712,0.698,0.686 and 0.678,respectively.The corresponding sensitivity and specificity at the optimal critical value were:69.0%and 73.4%for NLR,55.2%and 84.4%for PLR,50.0%and 87.3%for LMR,56.9%and 78.6%for AGR.AUC of the combined diagnosis of the four indicators was 0.838,which was significantly higher than each single indicator.The results of multivariate analysis showed that tumor diameter,pathological grade,NLR,PLR,LMR,AGR and AFP were all independent risk factors for hepatocellular carcinoma patients with MVI(OR=5.834,P=0.002;OR=3.442,P=0.005;OR=5.578,P=0.003;OR=4.421,P=0.002;OR=3.179,P=0.035;OR=3.520,P=0.004;OR=2.868,P=0.021).Conclusion NLR,PLR,LMR and AGR are risk factors for hepatocellular carcinoma complicated with MVI,which can predict the occurrence of MVI in hepatocellular carcinoma,and the combination of the four is better.