外周血炎症标志物对肝细胞癌的诊断价值研究

Study on the diagnostic value of inflammatory markers in peripheral blood for hepatocellular carcinoma

目的探讨外周血炎症标志物对肝细胞癌的诊断价值。方法收集2019年1月至2022年4月就诊于山东第一医科大学附属省立医院的431例肝细胞癌患者作为研究对象(肝细胞癌组),153例肝血管瘤患者作为对照组。计算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)、淋巴细胞与单核细胞比值(LMR)、淋巴细胞与C反应蛋白比值(LCR)、C反应蛋白与白蛋白比值(CAR)、白蛋白与总胆红素比值(ABR)、纤维蛋白原与白蛋白比值(FAR)、纤维蛋白原与前白蛋白比值(FPR);通过Logistic回归分析评估区分肝细胞癌与肝血管瘤的危险因素及保护因素;通过绘制受试者工作特征(ROC)曲线,分析以上指标对鉴别肝细胞癌和肝血管瘤的辅助诊断价值。结果Logistic回归分析发现,男性、年龄、NLR、CAR、FPR是肝血管瘤发展为肝细胞癌的危险因素(比值比=11.710、1.110、1.998、1.035、7.989,均P<0.05);ABR、PLR、LMR、FAR是肝血管瘤发展为肝细胞癌的保护因素(比值比=0.686、0.978、0.670、0.798,均P<0.05)。ROC曲线分析结果显示,在单项指标中,LMR、CAR、ABR、FPR对鉴别诊断肝细胞癌和肝血管瘤表现出较好的诊断效力[曲线下面积(AUC)>0.7],其中保护因素LMR的诊断效能最高,其AUC为0.761;联合检测NLR、PLR、LMR、LCR、CAR、ABR、FAR、FPR指标,其AUC为0.946,具有最高的诊断效能。结论NLR、PLR、LMR、LCR、CAR、ABR、FAR、FPR对肝细胞癌的诊断具有一定价值,其中NLR、CAR、FPR是肝细胞癌的危险因素,ABR、PLR、LMR、FAR是肝细胞癌的保护因素,以上指标联合检测可以提高对肝细胞癌的诊断效能。

Objective To investigate the diagnostic value of inflammatory markers in peripheral blood for hepatocellular carcinoma(HCC).Methods A total of 431 patients with HCC who were admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2019 to April 2022 were collected as the research objects(HCC group),and 153 patients with hepatic hemangioma were enrolled as the control group.The peripheral blood neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),lymphocyte to C-reactive protein ratio(LCR),C-reactive protein to albumin ratio(CAR),albumin to total bilirubin ratio(ABR),fibrinogen to albumin ratio(FAR),fibrinogen to prealbumin ratio(FPR)were calculated.Logistic regression analysis was used to evaluate the risk factors and protective factors for distinguishing HCC from hepatic hemangioma.The receiver operating characteristic(ROC)curve was drawn to analyze the auxiliary diagnostic value of the above indicators in the differential diagnosis of HCC and hepatic hemangioma.Results Logistic regression analysis showed that male,age,NLR,CAR and FPR were risk factors for the development of hepatic hemangioma into HCC(odds ratios=11.710,1.110,1.998,1.035,7.989,all P<0.05);ABR,PLR,LMR and FAR were protective factors for the development of hepatic hemangioma into HCC(odds ratios=0.686,0.978,0.670,0.798,all P<0.05).The results of ROC curve analysis showed that LMR,CAR,ABR,and FPR showed good diagnostic efficacy in the differential diagnosis of HCC and hepatic hemangioma[area under the curve(AUC)>0.7],among which the protective factor LMR had the highest diagnostic efficacy,with an AUC of 0.761.The AUC of combined detection of NLR,PLR,LMR,LCR,CAR,ABR,FAR,and FPR was 0.946,which had the highest diagnostic efficiency.Conclusions NLR,PLR,LMR,LCR,CAR,ABR,FAR and FPR have certain value in the diagnosis of HCC.Among them,NLR,CAR and FPR are risk factors of HCC,and ABR,PLR,LMR and FAR are protective factors of HCC.The combined detection of the above indicators can improve the diagnostic efficiency of HCC.