中性粒细胞与淋巴细胞比值对非小细胞肺癌发生放射性肺炎的预测价值  

Value of neutrophil to lymphocyte ratio in predicting radiation pneumonitis in patients with non-small cell lung cancer

作　　者：刘志远 洪梅 肖韡 廖辰 扬玖 Liu Zhiyuan;Hong Mei;Xiao Wei;Liao Chen;Yang Jiu(Department of Radiotherapy,Division of Thoracic Diseases,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学附属脑科医院胸科院区放疗科,210029

出　　处：《中华生物医学工程杂志》2020年第2期137-143,共7页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨放疗前后中性粒细胞与淋巴细胞的比值(NLR)的变化在预测非小细胞肺癌(NSCLC)患者发生放射性肺炎(RP)中的价值。方法选取2014年1月至2019年4月在本院确诊的局部晚期NSCLC患者80例,按照美国肿瘤放射治疗协作组和欧洲肿瘤治疗研究协作组(RTOG/EORTC)诊断分级标准,分为并发≥2级RP患者组和<2级RP患者组,动态观察两组患者其放疗前及治疗开始后1、2和3个月NLR和乳酸脱氢酶(LDH)、转化生长因子-β1(TGF-β1)水平的改变,并分析NLR与RP的相关性。对80例并发RP的NSCLC患者根据放疗后3个月NLR水平做ROC分析,评估NLR水平预测患者并发≥2级RP的价值。同时采用多因素Cox回归模型分析年龄、性别、KPS评分、分期和放射总剂量等临床特征与≥2级RP发生之间的关系。结果全组放疗的NSCLC患者中,有18例(22.5%)患者并发≥2级RP,有62例(77.5%)患者并发<2级RP。≥2级RP的发生与放射总剂量有关(P<0.05),而与性别、年龄、吸烟、病理、KPS评分及分期均无关(均P>0.05)。≥2级RP患者在接受放疗前NLR水平分别为2.01±0.21。放疗后1个月、2个月和3个月NLR分别为3.34±0.45、3.86±0.42和4.89±0.56,随时间延长逐渐升高(均P<0.05)。<2级RP患者在接受放疗前后的NLR水平差异无统计学意义(均P>0.05)。放疗后3个月≥2级RP患者的NLR水平明显高于<2级RP患者(4.89±0.56比2.38±0.54,P<0.05)。两组患者的LDH和TGF-β1水平在放疗前后无变化(均P>0.05)。ROC分析显示NLR诊断≥2级RP临界值2.861,其诊断≥2级RP的敏感度为90.2%,特异度为82.5%。COX多因素回归分析显示放射总剂量增加、NLR增高与≥2级RP的发生具有相关性。NLR≥2.861(OR=13.55,95%CI:3.233~38.220,P=0.001)和放射总剂量≥60 Gy(OR=3.872,95%CI:1.211~15.632,P=0.014)可作为接受放疗的肺癌患者发生≥2级RP的独立危险因素。结论放疗后NLR水平增高与肺癌患者发生≥2级RP明显相关,可作为接受放疗的肺癌患者�Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)changes before and after radiotherapy in predicting radiation pneumonitis(RP)in patients with non-small cell lung cancer(NSCLC).Methods Eighty patients with locally advanced NSCLC diagnosed in our hospital between January 2014 and April 2019 were includedand assigned into≥grade 2 RP group and<grade 2 RP group according to the grading diagnostic criteria of American Radiation Oncology Group and EuropeanOrganization for the Treatment of Cancer(RTOG/EORTC).The two groups were dynamically observed for NLR,lactate dehydrogenase(LDH)and transforming growth factor-β1(TGF-β1)before radiotherapy,and their changes at1,2 and 3 months after treatment initiation.The correlation between NLR and RP was analyzed.Complication with RP in the 80 NSCLC patients were analyzed by ROC based on NLR at 3 months after radiotherapy,to evaluate the value of NLR in predicting≥grade 2 RP.Meanwhile,multivariate Cox regression model was used to analyze the correlation of clinical characteristics such as age,gender,KPS score,and staging,with the total radiation dose.Results Of all NSCLC patients on radiotherapy,18(22.5%)cases were complicated with≥grade 2 RP,and 62(77.5%)with<grade 2 RP.The occurrence of≥grade 2 RP was related to the total radiation dose(P<0.05),but not to gender,age,smoking,pathology,KPS score and staging(all P>0.05).In patients with≥grade 2 RP,the NLR were 2.01±0.21 before radiotherapy,and was 1.34±0.45,3.86±0.42,and 4.89±0.56,respectively,at 1,2,and 3 months after radiotherapy,showing an upward trend overtime(all P<0.05).There was no statistically significant difference in NLR among patients with<grade 2 RP between baseline and after radiotherapy(all P>0.05).At 3 months after radiotherapy,the NLR was significantly higher in patients with≥grade 2 RP than those with<grade 2 RP(4.89±0.56 vs 2.38±0.54,P<0.05).The levels of LDH and TGF-β1 in the two groups remained unchanged across the radiotherapy(both P>0.05).ROC analysis showed that us

关 键 词：癌 非小细胞肺 辐射性肺炎 中性粒细胞与淋巴细胞比值 ROC曲线 COX回归 

分 类 号：R734.2[医药卫生—肿瘤]