CRP、NLR与局部晚期非小细胞肺癌放疗患者发生放射性肺炎的相关性

Correlation between CRP,NLR and radiation pneumonitis in patients with locally advanced non-small cell lung cancer undergoing radiotherapy

目的探讨C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)与局部晚期非小细胞肺癌(NSCLC)放疗患者发生放射性肺炎的相关性。方法回顾性分析186例行适形调强放射治疗的局部晚期NSCLC患者的临床资料,根据是否发生放射性肺炎将其分为肺炎组和对照组。比较两组放疗前、后的CRP水平及NLR,采用Logistic回归分析探讨影响局部晚期NSCLC放疗患者发生放射性肺炎的因素;采用受试者工作特征(ROC)曲线分析各指标对局部晚期NSCLC放疗患者发生放射性肺炎的预测价值。结果放疗后,肺炎组的CRP水平及NLR高于对照组(P<0.05)。两组的慢性阻塞性肺疾病、糖尿病、肺受照部位、同步化疗及放疗后3个月内序贯化疗占比比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,CRP水平及NLR升高、合并慢性阻塞性肺疾病、同步化疗是局部晚期NSCLC放疗患者发生放射性肺炎的独立危险因素(P<0.05)。ROC曲线显示,CRP及NLR的曲线下面积(AUC)分别为0.819、0.814,最佳截断值分别为10.5 mg/L、5.1,灵敏度分别为0.846、0.908,特异度分别为0.758、0.584。结论CRP水平及NLR升高与局部晚期NSCLC放疗患者发生放射性肺炎密切相关,且对其具有一定的预测价值。

Objective To investigate the correlation between C-reactive protein(CRP),neutrophil-to-lymphocyte ratio(NLR)and radiation pneumonitis in patients with locally advanced non-small cell lung cancer(NSCLC)undergoing radiotherapy.Methods The clinical data of 186 cases with locally advanced NSCLC who underwent intensity modulated radiation therapy were retrospectively analyzed.According to the occurrence of radiation pneumonitis,the patients were divided into pneumonia group and control group.The CRP level and NLR before and after radiotherapy were compared between the two groups.Logistic regression analysis was used to analyze the risk factors of radiation pneumonitis in patients with locally advanced NSCLC undergoing radiotherapy.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for radiation pneumonitis in patients with locally advanced NSCLC undergoing radiotherapy.Results After radiotherapy,the CRP level and NLR in the pneumonia group were higher than those in the control group(P<0.05).There were significant differences in the proportion of chronic obstructive pulmonary disease,diabetes,lung exposure site,concurrent chemotherapy and sequential chemotherapy within 3 months after radiotherapy between the two groups(P<0.05).Multivariate Logitic regression analysis showed that elevated CRP level and NLR,chronic obstructive pulmonary disease and concurrent chemotherapy were independent risk factors for radiation pneumonitis in patients with locally advanced NSCLC undergoing radiotherapy(P<0.05).The ROC curve showed that the area under the curve(AUC)of CRP and NLR were 0.819 and 0.814,the optimal cut-off values were 10.5 mg/L and 5.1,the sensitivity was 0.846 and 0.908,and the specificity was 0.758 and 0.584.Conclusion The elevated CRP level and NLR are closely related to the occurrence of radiation pneumonitis in patients with locally advanced NSCLC undergoing radiotherapy,and have certain predictive value for it.