Lymphocyte-to-monocyte ratio can predict mortality in pancreatic adenocarcinoma

AIMTo determine if the lymphocyte-to-monocyte ratio (LMR) could be helpful in predicting survival in patients with pancreatic adenocarcinoma. METHODSWe retrospectively reviewed the medical records of all patients diagnosed with pancreatic adenocarcinoma in the VA North Texas Healthcare System from January 2005 to December 2010. The LMR was calculated from peripheral blood cell counts obtained at the time of diagnosis of pancreatic cancer by dividing the absolute lymphocyte count by the absolute monocyte count. A Univariable Cox regression analysis was performed using these data, and hazard ratios (HR) and 95%CI were calculated. The median LMR (2.05) was used to dichotomize patients into high-LMR and low-LMR groups and the log rank test was used to compare survival between the two groups. RESULTSWe identified 97 patients with pancreatic adenocarcinoma (all men, 66% white, 30% African-American). The mean age and weight at diagnosis were 66.0 ± 0.9 (SEM) years and 80.4 ± 1.7 kg respectively. Mean absolute lymphocyte and monocyte values were 1.50 ± 0.07 K/μL and 0.74 ± 0.03 K/μL respectively. Mean, median and range of LMR was 2.36, 2.05 and 0.4-12 respectively. In the univariable Cox regression analysis, we found that an increased LMR was a significant indicator of improved overall survival in patients with pancreatic adenocarcinoma (HR = 0.83; 95%CI: 0.70-0.98; P = 0.027). Kaplan-Meier analysis revealed an overall median survival of 128 d (95%CI: 80-162 d). The median survival of patients in the high-LMR (> 2.05) group was significantly greater than the low-LMR group (≤ 2.05) (194 d vs 93 d; P = 0.03), validating a significant survival advantage in patients with a high LMR. CONCLUSIONThe LMR at diagnosis is a significant predictor for survival and can provide useful prognostic information in the management of patients with pancreatic adenocarcinoma.

The combined prognostic value of pretreatment neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in stage IE/IIE extranodal natural killer/T-cell lymphoma

Objective This study aimed to explore the combined prognostic value of pretreatment neutrophil-tolymphocyte ratio(NLR), lymphocyte-to-monocyte ratio(LMR), and platelet-to-lymphocyte ratio(PLR) in newly diagnosed IE/IIE extranodal natural killer/T-cell lymphoma(ENKTL) treated with a P-Gemox regimen combined with radiotherapy or radiotherapy alone.Methods A total of 132 patients from 2009 to 2017 at the Sichuan Cancer Hospital were enrolled in the study. The cutoff values of NLR, LMR, and PLR using overall survival(OS) rate as an endpoint were obtained by the receiver operating curve. Results The cutoff value of NLR was 3.5. Patients with high NLR had significantly shorter progressionfree survival(PFS)(P < 0.001) and OS(P < 0.001) than those with low NLR. Similarly, the cutoff value of LMR was 3.0. The high LMR group had significantly longer PFS(P=0.001) and OS(P < 0.001) than the low LMR group. Similarly, the cutoff value of PLR was 191.7. The high PLR group was significantly associated with poor PFS(P < 0.001) and OS(P < 0.001) than the low PLR group. Furthermore, combining NLR, LMR, and PLR to build a new model to stratify patients into low-, intermediate-, intermediate-high-, and high-risk groups, there were also significant differences in PFS(P < 0.001) and OS(P < 0.001). The univariate analysis showed that presenting B symptoms, stage IIE, local tumor invasion, Eastern Cooperative Oncology Group score ≥ 2, elevated lactate dehydrogenase level, elevated NLR, decreased LMR, and elevated PLR were significantly associated with poor survival. The multivariate analysis demonstrated that PLR was an independent prognostic factor for both PFS(hazard ratio [HR]= 2.073, 95% confidence interval [CI]= 1.080–3.981, P = 0.028) and OS(HR = 2.127, 95% CI = 1.102–4.107, P = 0.025).Conclusion Elevated pretreatment PLR was a novel simple predictor of poor survival in patients with stage IE/IIE ENKTL. Combining NLR, LMR, and PLR could provide additional stratification.

NLR、dNLR、LMR用于预测经皮肾镜术后全身炎症反应综合征的临床研究

目的探讨尿石症患者行经皮肾镜碎石取石术(percutaneous nephrolithotomy, PCNL)后全身炎症反应综合征(systemic inflammatory response syndrome, SIRS)发生的危险因素,以及术前中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)、衍生中性粒细胞/淋巴细胞比值(derived neutrophil to lymphocyte ratio,dNLR)、淋巴细胞/单核细胞比值(lymphocyte to monocyte ratio,LMR)在预测PCNL术后SIRS发生中的价值。方法选取2017年1月至2019年6月贵州省人民医院诊治的292例PCNL术后患者的临床资料及体检健康对照者120例的相关资料作为研究对象。依据PCNL术后是否发生SIRS分为非SIRS组和SIRS组,对两组患者的临床资料进行统计学分析。结果 292例结石患者中,PCNL术后发生RIRS共88例,与非SIRS组相比较,在性别、白细胞、中性粒细胞、淋巴细胞、肌酐、尿素氮、GFR、术中尿培养、结石负荷、手术时间、NLR、dNLR、LMR方面,差异具有统计学意义(P<0.05);Logistic回归分析显示性别(HR=0.179,P=0.022)、白细胞(HR=2.321,P<0.001)、中性粒细胞(HR=1.411,P=0.046)、淋巴细胞(HR=0.179,P=0.003)、术中尿培养(HR=2.437,P=0.018)、结石负荷(HR=1.005,P<0.003)、手术时间(HR=1.028,P<0.029)、鹿角型肾结石(HR=5.775,P=0.017)、NLR(HR=2.905,P=0.004)、dNLR(HR=14.687,P=0.002)是结石患者行PCNL术后发生SIRS发生的独立危险因素。ROC曲线图结果显示术前NLR曲线下面积(AUC)为0.831,其敏感度和特异度均为75.7%,dNLR曲线下面积为0.813,其敏感度和特异度分别为84.9%、66.9%。结论性别、术前NLR、dNLR值、结石负荷、术中尿培养、鹿角型肾结石为PCNL术后SIRS的发生的独立危险因素,其中术前NLR、dNLR值具有较高的敏感性和特异性,具有简便、安全、经济的优点,是预测术后感染并发症发生的一个良好指标。

术前外周血中NLR、PLR、LMR与早期宫颈癌患者预后的相关性研究

目的探讨接受早期宫颈癌根治术患者术前外周血中中性粒/淋巴细胞(neutrophil to lymphocyte ratio,NLR)、血小板/淋巴细胞(platelet to lymphocyte ratio,PLR)及单核/淋巴细胞(Lymphocyte to monocyte ratio,LMR)与预后的关系。方法分析2012-2018年新疆医科大学第一附属医院妇科确诊为宫颈癌(I-IIa期)并接受早期根治术的116例患者的相关资料并计算NLR、PLR、LMR,讨论高、低比值组与临床资料的相关性及其对预后的影响。结果高、低NLR组在年龄、肿块大小方面的差异有统计学意义(P<0.05);高低PLR组在年龄、淋巴结转移、肿块大小、脉管浸润方面的差异有统计学意义(P<0.05);高、低LMR组在年龄、脉管浸润方面的差异有统计学意义(P<0.05)。高NLR组患者5年生存率(34.4%)低于低NLR组(63.3%),高PLR组患者5年生存率(45.6%)低于低PLR组(55.8%),高LMR组患者5年生存率(57.6%)高于低LMR组(37.6%),差异均有统计学意义(P<0.05)。单因素分析显示,浸润深度≥1/2、NLR≥2.77、PLR≥133.57、LMR<4.04、临床分期为II期、有淋巴结转移是影响患者生存情况的危险因素。多因素分析显示,NLR≥2.77、浸润深度≥1/2、临床分期为II期是影响患者生存率的独立危险因素。结论宫颈癌患者术前高NLR、高PLR及低LMR是提示预后不良的指标,NLR较其他2个比值对预后的预测更具意义。

外周血NLR及LMR对局部晚期鼻咽癌长期生存预后的评估价值

目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)对局部晚期鼻咽癌(NPC)患者预后评估的临床意义。方法回顾性分析200例完成诱导化疗联合同步放化疗治疗的局部晚期鼻咽癌患者(Ⅲ-Ⅳa期)的临床病理资料及随访记录,收集患者行诱导化疗前的NLR、LMR,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC);判定患者NLR、LMR的最佳临界值;使用Cox风险模型分析确定影响局部晚期鼻咽癌患者5年总生存率(OS)及无进展生存率(PFS)的独立危险因素;根据NLR、LMR的最佳临界值,将患者分为高风险组(NLR≥3.81且LMR<2.03)30例、中风险组(NLR<3.81且LMR<2.03,或NLR≥3.81且LMR≥2.03)35例及低风险组(NLR<3.81且LMR≥2.03)135例,通过Kaplan-Meier分析其对生存的影响,并对3组的T、N分期比较进行亚组分析。结果ROC曲线计算结果显示,NLR、LMR对局部晚期鼻咽癌患者5年OS率的最佳临界值分别为3.81和2.03;多因素Cox回归分析提示N分期(HR=0.425,95%CI为0.185~0.975,P<0.05)、NLR≥3.81(HR=0.117,95%CI为0.048~0.282,P<0.05)、LMR<2.03(HR=0.449,95%CI为0.212~0.952,P<0.05)是OS独立危险因素,同时N分期(HR=0.288,95%CI为0.141~0.589,P<0.05)、NLR≥3.81(HR=0.215,95%CI为0.110~0.420,P<0.05)是PFS的独立危险因素;高风险组、中风险组及低风险组患者的5年OS率分别为13.3%、68.6%、94.1%,差异具有统计学意义(χ^(2)=83.973,P<0.05),5年PFS率分别为6.7%、57.1%、84.4%,差异具有统计学意义(χ^(2)=47.286,P<0.05),3组的N分期为N3的患者数所占比率分别为低风险组35.6%、中风险组37.1%、高风险组80%,差异具有统计学分析意义(P<0.05)。结论局部晚期鼻咽癌患者治疗前外周血NLR和LMR对患者的5年OS及PFS有较好预测价值,且联合NLR和LMR预测的价值可能更大。

自身免疫性肝炎NLR、LMR、PLR及肝功能指标检测结果分析

目的研究自身免疫性肝炎(AIH)患者中性粒细胞-淋巴细胞比值(NLR)、淋巴细胞-单核细胞比值(LMR)、血小板至淋巴细胞比值(PLR)及肝功能指标的变化情况,为患者的诊断提供实验室指标参考依据。方法选择2016年3月至2018年6月西安市中医医院收治的80例AIH患者作为观察组,并选择同期健康体检者60例为对照组。比较观察组患者入院时与对照组受检者的血清NLR、LMR、PLR水平和血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转移酶(γ-GT)等肝功能相关指标。上述指标与AIH的相关性采用二元Logistic回归方法分析,采用受试者工作特征(ROC)曲线评价各指标对AIH的诊断价值。结果观察组患者的NLR为3.15±1.21,明显高于对照组的1.23±0.21,LMR和PLR分别为3.23±2.11、82.91±21.12,明显低于对照组的95.12±1.34、164.42±33.34,差异均有统计学意义(P<0.05);观察组患者的TBIL、ALT、AST及γ-GT水平分别为(104.78±73.62)mol/L、(198.23±102.34)U/L、(1138.98±37.42)U/L、(1156.05±92.30)g/L,明显高于对照组的(12.13±9.51)mol/L、(27.24±12.42)U/L、(22.73±9.35)U/L、(34.75±15.2)g/L,差异均有统计学意义(P<0.05);经Logistic回归分析结果显示,NLR、LMR、PLR是AIH肝硬化的独立危险因素,其OR(95%CI)分别为1.256(1.113~1.343)、1.339(1.128~1.624)和1.475(1.034~2.046);三者诊断AIH的ROC曲线下面积(AUC)分别为0.823、0.735和0.674。结论NLR、LMR、PLR是AIH的危险因素,NLR、LMR、PLR以及肝功能指标与AIH发生相关,对AIH具有一定诊断价值。

术前LMR与晚期卵巢癌满意肿瘤细胞减灭术的相关性分析

目的探讨术前外周血淋巴细胞/单核细胞计数比(lymphocyte-to-monocyte ratio,LMR)与晚期卵巢癌满意肿瘤细胞减灭术(optimal debulking surgery,ODS)的相关性。方法回顾性分析2019年1月至2022年1月在南充市高坪区人民医院和川北医学院附属南充市中心医院初始治疗为手术治疗的102例晚期卵巢癌患者的临床资料。根据患者是否实现ODS,分为ODS组和不满意肿瘤细胞减灭术(suboptimal debulking surgery,SODS)组,比较两组的临床指标(病理学类型、恶性腹水、淋巴结转移、肿瘤标志物等)。根据受试者工作特征(ROC)曲线分析得到LMR预测晚期卵巢癌ODS的最佳截止值。采用binary logistic分析影响卵巢癌ODS的可能因素。结果102例晚期卵巢癌患者中,70例行ODS,32例行SODS。根据约登指数最大原则,LMR预测晚期卵巢癌ODS的最佳临界值为3.67,此时ROC曲线下面积为0.860(95%CI:0.778~0.921,P<0.001),灵敏度为87.1%,特异度为84.4%。多因素binary logistic分析结果提示LMR(OR=6.570,95%CI:1.740~24.80,P=0.005)、血清CA125、恶性腹水(≤500 mL)、Suidan评分与晚期卵巢癌ODS有关。结论术前外周血LMR(LMR>3.67)可单独或联合Suidan评分作为预测晚期卵巢癌初治时实现ODS的参考指标。

直肠癌脉管癌栓与术前NLR和LMR关系

目的探讨直肠癌术前中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、淋巴细胞与单核细胞比值(lymphocyte-to-monocyte ratio,LMR)与术后病理结果脉管癌栓之间的关系。方法回顾性分析2014-01~2017-12郑州大学第二附属医院普外科初诊入院并行手术根治的321例直肠癌患者术前血常规及临床病理资料,根据患者术后病理资料将其分为有脉管癌栓组84例和无脉管癌栓组237例,分析脉管癌栓与术前NLR、LMR及临床病理资料之间关系。结果单因素分析中T分期、N分期、分化程度、术前NLR及LMR与直肠癌脉管癌栓差异有统计学意义(P均<0.05),多因素分析结果显示N分期中N 1+N 2、术前高NLR及术前低LMR为其独立危险因素(P均<0.05)。结论术前NLR、LMR的高低,可协助术者判断直肠癌患者有无脉管癌栓,为肿瘤分期提供帮助,术前高NLR及低LMR提示直肠癌脉管癌栓可能性大。

Development and validation of a nomogram including lymphocyte-to-monocyte ratio for initial prostate biopsy:a double-center retrospective study

Here,we developed a prostate cancer(PCa)risk nomogram including lymphocyte-to-monocyte ratio(LMR)for initial prostate biopsy,and internal and external validation were further conducted.A prediction model was developed on a training set.Significant risk factors with P<0.10 in multivariate logistic regression models were used to generate a nomogram.Discrimination,calibration,and clinical usefulness of the model were assessed using C-index,calibration plot,and decision curve analysis(DCA).The nomogram was re-examined with the internal and external validation set.A nomogram predicting PCa risk in patients with prostate-specific antigen(PSA)4-10 ng ml^(-1)was also developed.The model displayed good discrimination with C-index of 0.830(95%confidence interval[Cl]:0.812-0.852).High C-index of 0.864(95%Cl:0.840-0.888)and 0.871(95%Cl:0.861-0.881)was still reached in the internal and external validation sets,respectively.The nomogram exhibited better performance compared to the nomogram with PSA only(C-index:0.763,95%Cl:0.746-0.780,P<0.001)and the nomogram with LMR excluded(C-index:0.824,95%Cl:0.804-0.844,P<0.010).The calibration curve demonstrated good agreement in the internal and external validation sets.DCA showed that the nomogram was useful at the threshold probability of>4%and<99%.The nomogram predicting PCa risk in patients with PSA 4-10 ng ml^(-1)also displayed good calibration and discrimination performance(C-index:0.734,95%Cl:0.708-0.760).This nomogram incorporating age,PSA,digital rectal examination,abnormal imaging signals,PSA density,and LMR could be used to facilitate individual PCa risk prediction in initial prostate biopsy.

Lymphocyte-to-monocyte ratio is a short-term predictive marker of ulcerative colitis after induction of advanced therapy

Advanced therapies for patients with mild-to-severe ulcerative colitis(UC)may result in treatment failure.We examined whether the lymphocyte-to-monocyte ratio(L/M ratio)could predict the failure of advanced therapies.This retrospective,observational,cohort study included 73 patients who were treated with advanced therapies at the Hamamatsu University School of Medicine(Shizuoka,Japan)between February 2011 and November 2020.The patients were divided into the nonfailure and failure groups,and their leukocyte counts and ratios before induction were examined.Univariate and multivariate analyses were performed to identify the prognostic factors.Advanced therapies failed within 3 months in 15(20.5%)patients.Only the L/M ratio was significantly lower in the failure group than in the non-failure group(P=0.004).Receiveroperating characteristic(ROC)curve analysis revealed that an L/M ratio of ≤3.417 was predictive of treatment failure;the area under the curve(AUC)was 0.747(95%CI,0.620–0.874).Kaplan–Meier analysis revealed that the failure-free rate was significantly lower in the group with an L/M ratio of≤3.417 than in the group with an L/M ratio of>3.417(log-rank test P=0.002).Cox proportional hazard regression analysis identified an L/M ratio of≤3.417 as an independent risk factor for failure within 3 months after the induction of advanced therapies.Furthermore,ROC analysis of patients who did not receive immunomodulators also revealed that the cut-off L/M ratio was 3.417 and the AUC was 0.796(95%CI,0.666–0.925).In patients receiving advanced therapies for active UC,the L/M ratio can predict treatment failure within 3 months.L/M ratios could facilitate the transition from advanced therapies to subsequent treatments.

Feasibility of lymphocyte-to-monocyte ratio in predicting no-reflow phenomenon in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]

淋巴细胞与单核细胞比值对上皮性卵巢癌预后价值的临床分析

目的探讨淋巴细胞与单核细胞比值(LMR)在上皮性卵巢癌(EOC)预后评估中的价值。方法收集2006年2月至2014年4月EOC患者189例,采用受试者工作曲线(ROC)分析EOC患者LMR的最佳诊断值;分析LMR表达与EOC临床病理特征的关系;采用Cox风险比例模型分析影响EOC预后的因素。结果根据ROC曲线分析显示,LMR的截断值为1.850;将189例患者分为低LMR组(n=39,LMR≤1.850)和高LMR组(n=150,LMR>1.850)。LMR水平与年龄、CA125、FIGO分期、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、白蛋白水平有关(P<0.05),与组织学分级、病理类型、血红蛋白含量和残留病灶无关(P>0.05)。高LMR组、低LMR组的中位无进展生存期分别为91个月和65个月,中位总生存期分别为105个月和67个月,差异均有统计学意义(P<0.001)。Cox风险比例模型分析显示,年龄、CA125、FIGO分期、LMR是影响无进展生存期的独立因素(P<0.05),年龄、FIGO分期、LMR是影响总生存期的独立因素(P<0.05)。结论 LMR是影响EOC患者预后的独立因素,能作为标志物对EOC患者进行预后评估。

外周血炎性标志物在甲状腺癌中的应用进展

甲状腺癌是内分泌系统最常见的恶性肿瘤,近年来其发病率在世界范围内呈上升趋势,虽然总体治愈率高,但局部复发或远处转移也较常见,另有部分患者因肿瘤组织分化低,疾病进展较快而死亡。免疫反应和炎症反应在肿瘤的发生、发展中起着重要的作用,研究表明外周血中某些炎性细胞的数目及其比值是恶性肿瘤的重要预后因子,如血小板、中性粒细胞、淋巴细胞、单核细胞等。本文就外周血血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、系统免疫炎症指数(SII)、淋巴细胞/单核细胞比值(LMR)及C反应蛋白(CRP)在甲状腺癌中的应用进展作一综述,旨在为甲状腺癌的综合诊疗提供更全面的参考。

改良格拉斯哥预后评分及相关炎性指标与骨肉瘤患者临床预后的关系

目的:探讨改良格拉斯哥预后评分(mGPS)、血小板/淋巴细胞比值(PLR)和淋巴细胞/单核细胞比值(LMR)对骨肉瘤患者预后预测的价值。方法:收集2000年至2018年宜宾市2所综合医院收治的骨肉瘤患者的病历资料,随访患者临床结局,采用ROC曲线分析相关指标预测患者预后的曲线下面积和最佳截断值,Kaplan-Meier法绘制生存曲线,Log-rank检验和Cox回归分析患者预后的影响因素。结果:92例患者平均生存时间50个月,随访期内发生死亡47例(51.09%)。PLR和LMR的ROC曲线下面积分别为0.731和0.630,最佳截断值为137和3.516(P<0.05)。Cox回归分析显示:诊断时有无转移和mGPS评分是患者预后的影响因素,诊断时有转移、mGPS=1分和2分的HR(95%CI)分别为3.669(1.743~7.721)、10.860(4.072~28.965)和26.240(8.977~76.700)(P<0.05)。诊断时有转移和无转移的患者5年生存率分别为10.26%和79.25%,mGPS评分为0、1和2分的患者5年生存率分别为87.76%、7.41%和6.25%。结论:骨肉瘤患者预后与mGPS评分和诊断时有无转移有关。

相关炎性指标与非小细胞肺癌术后化疗出现骨髓抑制的预测价值

目的探讨中性粒细胞与淋巴细胞比率(neutrophil-lymphocyte ratio,NLR)、血小板与淋巴细胞比率(platelet to lymphocyte ratio,PLR)、淋巴细胞与单核细胞比率(lymphocyte to monocyte ratio,LMR)与非小细胞肺癌(non-small cell lung cancer,NSCLC)术后患者接受首次化疗后出现骨髓抑制的相关性。方法收集2017年1月-2020年11月在郑州大学第五附属医院胸外科收治的Ⅰ-Ⅳ期初次接受一线化疗的NSCLC术后患者60例,患者年龄44-74岁。根据患者初次化疗后是否出现骨髓抑制分为2组,即发生骨髓抑制患者19例(31.67%)和未发生骨髓抑制患者41例(68.33%)。比较化疗后发生骨髓抑制相关影响因素的分布差异,分别分析影响患者化疗后出现骨髓抑制的危险因素,纳入二元Logistic回归探讨NLR、PLR、LMR对NSCLC术后初次化疗后出现骨髓抑制的相关性。结果多因素Logistic回归分析结果显示,PLR(OR=7.482,P=0.019)、NLR(OR=0.078,P=0.040)是NSCLC患者化疗后出现骨髓抑制的影响因素,而LMR(OR=0.214,P=0.114)与患者初次化疗后发生骨髓抑制之间比较,差异无统计学意义。结论PLR、NLR是NSCLC术后患者初次化疗后发生骨髓抑制的独立危险因素,并且PLR的预测价值更高。

术前纤维蛋白原联合淋巴细胞与单核细胞比值对非小细胞肺癌患者预后的评估价值

目的:探讨术前纤维蛋白原(fibrinogen,Fbg)联合淋巴细胞与单核细胞比值(lymphocyte to monocyte ratio,LMR)评分(FLMR)与非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的相关性。方法:回顾性分析2006年1月至2009年12月天津医科大学肿瘤医院行根治性手术切除的589例NSCLC患者的临床病例资料。根据受试者工作特征(ROC)曲线判定Fbg及LMR的界限值,根据F-LMR评分原则将患者分为3组:F-LMR 0分、F-LMR 1分、F-LMR 2分。通过χ2检验分析其与患者临床病理因素的关系,Kaplan-Meier法进行生存分析,运用Log-rank法进行差异性检验,Cox比例风险模型进行单因素与多因素回归分析。结果:根据ROC曲线,3.48 g/L、3.23分别作为Fbg和LMR的界值。F-LMR 0分215例、F-LMR 1分228例、F-LMR 2分146例,术前F-LMR评分与年龄、性别、吸烟史、肿瘤位置、手术类型、病理分期、病理类型、肿瘤大小有显著相关(P<0.05)。单因素分析显示:肿瘤位置、手术类型、病理分期、肿瘤大小、F-LMR评分、LMR及Fbg水平是影响NSCLC患者预后的危险因素(P<0.05);多因素分析结果表明:病理分期(DFS:HR:1.700,95%CI:1.483~1.950,P<0.001;OS:HR:1.703,95%CI:1.486~1.952,P<0.001)和F-LMR评分(DFS:HR:1.264,95%CI:1.077~1.484,P=0.004;OS:HR:1.301,95%CI:1.107~1.528,P=0.001)是影响患者预后的独立危险因子。结论:术前F-LMR评分可作为预测行根治性切除的非小细胞肺癌患者预后的指标。

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

BACKGROUND Platelet count or complete blood count(CBC)-based ratios including lymphocyteto-monocyte(LMR),neutrophil-to-lymphocyte(NLR),hemoglobin-to-platelet(HPR),red blood cell count distribution width-to-platelet(RPR),and platelet-tolymphocyte(PLR)ratio are good predictors of colorectal cancer(CRC)survival.Their change in time is not well documented,however.AIM To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties,comorbidities,and anamnestic data.METHODS A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients,who attended at Semmelweis University,Budapest.CBC ratios and two additional newly defined personalized platelet count metrics(pPLT_(D)and pPLT_(S),the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery,respectively)were recorded.RESULTS The 835 CRC patients had a total of 4608 measurements(5.52 visits/patient,in average).Longitudinal survival models revealed that the increases/decreases in LMR[hazard ratio(HR):0.4989,P<0.0001],NLR(HR:1.0819,P<0.0001),HPR(HR:0.0533,P=0.0038),pPLT_(D)(HR:4.9229,P<0.0001),and pPLT_(S)(HR:4.7568,P<0.0001)values were poor prognostic signs of disease-specific survival.The same was obtained for all-cause mortality.Most abnormal changes occurred within the first 3 years after the diagnosis of CRC.RPR and PLR had an only marginal effect on diseasespecific(P=0.0675)and all-cause mortality(Bayesian 95%credible interval:0.90–186.05),respectively.CONCLUSION LMR,NLR,and HPR are good metrics to follow the prognosis of the disease.pPLT_(D)and pPLT_(S)perform just as well as the former,while the use of RPR and PLR with the course of the disease is not recommended.Early detection of the abnormal changes in pPLT_(D),pPLT_(S),LMR,NLR,or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.

阿帕替尼联合化疗治疗转移性结直肠癌的疗效

目的比较阿帕替尼联合化疗与阿帕替尼单药治疗转移性结直肠癌(mCRC)的疗效和安全性。方法共纳入62例患者,将其分为阿帕替尼联合化疗组(联合组)和阿帕替尼单药组(单药组)。记录并评估2组的无进展生存期(PFS)、总生存期(OS)、客观反应率(ORR)、疾病控制率(DCR)、治疗前后的实验室检查结果和治疗相关不良事件。此外,进行单因素和多因素Cox回归分析PFS和OS的独立预后因素。结果与单药组相比,联合组显著延长了OS(8.1 m vs 7.7 m,P=0.021),但2组PFS比较差异无统计学意义(3.65 m vs 3.15 m,P=0.100)。联合组的ORR为8.3%(3/36),DCR为80.6%(29/36),单药组的ORR和DCR分别为7.7%(2/26)、61.5%(16/26)。多因素分析提示治疗方案[风险比(HR)=1.946,95%CI:1.014~3.738,P=0.045]和原发肿瘤的位置(HR=3.486,95%CI:1.374~8.844,P=0.009)是OS的重要因素。联合组治疗后的平均红细胞体积(MCV)和平均红细胞体积与红细胞比值(MCV/RBC)均高于单药组(P<0.05),而联合组治疗后的淋巴细胞与单核细胞比值(LMR)和血红蛋白、白蛋白、淋巴细胞和血小板计数评分(HALP评分)均低于单药组(P<0.05)。联合组3/4级血小板减少(11.1%)高于单药治疗组(0%),其他不良反应2组比较差异无统计学意义。结论在mCRC后线治疗中,阿帕替尼联合化疗比单药治疗能延长OS,且未增加不良反应。

神经精神系统性红斑狼疮(NPSLE)患者的临床特点及危险因素分析

目的分析神经精神系统性红斑狼疮(NPSLE)患者的临床特点,探究影响NPSLE发生的危险因素。方法入组63例NPSLE患者和61例非NPSLE的SLE患者,收集两组患者的临床表现及实验室检查数据,总结NPSLE的疾病特点,通过多元Logistics回归分析影响NPSLE发生的危险因素。结果NPSLE患者最常见的临床表现为头痛(39.7%)、情感障碍(33.3%)和认知功能障碍(30.2%);头颅核磁异常(63.5%)和脑脊液蛋白阳性率(52.4%)较高。与非NPSLE组患者相比,NPSLE患者在雷诺现象、肾脏受累、抗核糖核蛋白(RNP)抗体、抗核糖体P蛋白、低补体血症、淋巴细胞/单核细胞比率(LMR)、中性粒细胞/淋巴细胞比率(NLR)显著升高。通过多因素Logistics回归分析表明,肾脏受累、雷诺现象、抗核糖体P蛋白抗体阳性、LMR、NLR升高是NPSLE发生的独立危险因素。结论PSEL患者最常见的症状为头痛,头颅核磁和脑脊液检查异常较为多见。SLE患者出现肾脏受累、雷诺现象、抗核糖体P蛋白抗体阳性,LMR、NLR升高更容易出现NPSLE。

细菌性急性上呼吸道感染患儿血常规、炎症因子水平变化及其相关性

目的探讨细菌性急性上呼吸道感染患儿血常规、炎症因子水平的变化及其相关性。方法选择2019年2年至2020年3月陕西省核工业二一五医院儿科收治的100例细菌性急性上呼吸道感染患儿作为观察组,并选择100例体检健康的儿童作为对照组。比较两组儿童的血常规[中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、白细胞(WBC)、平均血小板体(MPV)、红细胞分布宽度(RDW)]和炎症因子[白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平,并采用Pearson相关分析法分析血常规NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-α的相关性。结果观察组患儿的血常规NLR、LMR、WBC、MPV、RDW和IL-6、CRP、TNF-α水平分别为5.68±0.20、22.49±5.01、(15.28±3.63)×109L、(8.18±1.26)fL、(22.11±4.30)%、(410.12±40.04)pg/L、(19.57±4.10)mg/L、(396.22±35.48)ng/mL,明显高于对照组的2.02±0.24、12.15±2.30、(8.05±1.29)×109L、(4.87±0.75)fL、(11.30±2.74)%、(221.20±23.38)pg/L、(12.30±2.51)mg/L、(300.51±20.60)ng/mL,差异均有统计学意义(P<0.05);经Pearson相关分析结果显示,NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-α均呈正相关(r值=0.418、0.704、0.501、0.590、0.620、0.426、0.627、0.574、0.672、0.881、0.856、0.535、0.610、0.712、0.419,P<0.05)。结论细菌性急性上呼吸道感染患儿的血常规NLR、LMR、WBC、MPV、RDW明显高表达,且与IL-6、CRP、TNF-α水平密切相关,可为临床的诊疗提供参考。