血清乳酸脱氢酶、中性粒细胞/淋巴细胞比值、血浆纤维蛋白原/前白蛋白比值对晚期结直肠癌患者姑息化疗效果与不良反应的评价

Evaluation value of serum lactate dehydrogenase level,neutrophil-lymphocyte ratio and plasma fibrinogen-prealbumin ratio on palliative chemotherapy effect and adverse reactions in patients with advanced colorectal cancer

目的分析血清乳酸脱氢酶(LDH)水平、中性粒细胞/淋巴细胞比值(NLR)、血浆纤维蛋白原/前白蛋白比值(FPR)对晚期结直肠癌患者姑息化疗效果与不良反应的评价价值。方法选取2021年3月至2023年3月安徽省皖南康复医院收治的80例晚期结直肠癌患者,均行氟尿嘧啶/亚叶酸钙、奥沙利铂和伊立替康的三药联合方案联合西妥昔单抗姑息化疗治疗。于化疗2周期后评估其化疗效果,并记录化疗期间不良反应发生情况。比较不同化疗效果以及发生、未发生不良反应患者化疗前LDH、NLR、FPR和临床资料差异,使用Logistic回归模型归纳影响患者姑息化疗效果和不良反应的相关因素。结果80例患者均完成2周期化疗,化疗2周期后CR 0例、PR 28例、SD 30例、PD 22例,总有效率为35.00%(28/80)、疾病控制率为72.50%(68/80)。患者不良反应以Ⅰ~Ⅱ级恶心、腹泻、白细胞减少为主,Ⅲ~Ⅳ级不良反应少见,不良反应发生率为63.75%。多因素分析示,年龄≥60岁、低分化、LDH≥245 U/L、NLR≥3.21、FPR≥0.10均为影响晚期结直肠癌患者姑息化疗近期疗效的独立危险因素(P<0.05);年龄≥60岁、FPR≥0.10均为影响晚期结直肠癌患者姑息化疗不良反应的独立危险因素(P<0.05)。结论晚期结直肠癌患者姑息化疗效果与年龄、LDH、NLR、FPR有关,其不良反应与年龄、FPR有关,化疗前完善临床资料采集和实验室指标检测,有望指导疗效和不良反应预测。

Objective To analyze the evaluation value of serum lactate dehydrogenase(LDH)level,neutrophil-lymphocyte ratio(NLR)and plasma fibrinogen-prealbumin ratio(FPR)in palliative chemotherapy for patients with advanced colorectal cancer.Methods From March 2021 to March 2023,80 patients with advanced colorectal cancer in our hospital were selected,and all of them were treated with FOLFOXIRI(fluorouracil/calcium folinate,oxaliplatin and irinotecan)combined with cetuximab palliative chemotherapy.The effect of chemotherapy was evaluated after 2 cycles of chemotherapy,and the occurrence of adverse reactions during chemotherapy was recorded.The differences of LDH,NLR,FPR and clinical data between patients with different chemotherapy effects and patients with and without adverse reactions before chemotherapy were compared.Logistic regression model was used to summarize the related factors affecting the effect and adverse reactions of palliative chemotherapy.Results A All 80 patients completed 2 cycles of chemotherapy.After 2 cycles of chemotherapy,there were 0 case of CR,28 cases of PR,30 cases of SD and 22 cases of PD.The total effective rate was 35.00%(28/80)and the disease control rate was 72.50%(68/80).The main adverse reactions were gradeⅠ-Ⅱnausea,diarrhea and leukopenia,and gradeⅢ-Ⅳadverse reactions were rare,with the incidence of adverse reactions being 63.75%.Multivariate analysis showed that age≥60 years,poor differentiation,LDH≥245 U/L,NLR≥3.21,FPR≥0.10 were all independent risk factors affecting the short-term efficacy of palliative chemotherapy in patients with advanced colorectal cancer(P<0.05).Age≥60 years and FPR≥0.10 were independent risk factors for adverse reactions of palliative chemotherapy in patients with advanced colorectal cancer(P<0.05).Conclusion The effect of palliative chemotherapy in patients with advanced colorectal cancer is related to age,LDH,NLR and FPR,and its adverse reactions are related to age and FPR.It is expected to guide the prediction of curative effect and adverse reactions by improving clinical data collection and laboratory indicators before chemotherapy.