中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值在预测葡萄胎恶变中的价值  

Predicting malignant transformation of hydatidiform mole by neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio

作　　者：雷欣蓉 陈晓琦 杨勇莉[1] 秦阿妮 LEI Xinrong;CHEN Xiaoqi;YANG Yongli;QIN Ani(Department of Gynecology, Affiliated Hospital of Qinghai University, Xining 810000, China)

机构地区：[1]青海大学附属医院妇科,西宁810000

出　　处：《中国生育健康杂志》2022年第4期342-346,共5页Chinese Journal of Reproductive Health

基　　金：青海大学中青年基金项目(2019-QYY-11)。

摘　　要：目的评价葡萄胎患者清宫前后的中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)和β-人绒毛膜促性腺激素(β-hCG)单独或联合应用在预测葡萄胎恶变为妊娠滋养细胞肿瘤(GTN)中的价值。方法选取2015年1月至2017年12月来自青海省各地区就诊于青海大学附属医院及青海省红十字医院妇科,全程行规范化诊断治疗及定期随访的葡萄胎患者进行研究。共纳入175例葡萄胎患者,根据清宫术后2年血β-hCG的随访结果,将患者分为恶变组(38例)和治愈组(137例)。收集患者首次清宫术前后的血常规结果,包括中性粒细胞绝对值(N)、淋巴细胞绝对值(L)和血小板计数(PLT),计算NLR及PLR,通过受试者工作特征曲线(ROC)计算曲线下面积(AUC)。结果恶变组首次清宫前的N、NLR、PLR及lgβ-hCG值显著高于治愈组(P<0.05);治愈组首次清宫前L计数明显高于恶变组(P<0.05);当清宫前NLR=3.23时,AUC为0.727(P<0.05,95%CI:0.63~0.82);当清宫前的PLR=159.38时,AUC为0.675(P<0.05,95%CI:0.58~0.78);当清宫后的PLR=129.2时,AUC为0.636(P<0.05,95%CI:0.56~0.71);首次清宫前NLR联合PLR预测葡萄胎恶变的AUC为0.724(P<0.05,95%CI:0.65~0.79)。结论葡萄胎患者首次清宫前NLR及PLR在预测葡萄胎恶变中存在一定价值,首次清宫后的PLR值在预测葡萄胎恶变中也具有一定的价值。Objective To explore whether neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)orβ-human chronic gonadotropin(β-hCG)along or in combination can predict the risk of malignant transformation from hydatidiform mole to gestational trophoblastic neoplasm(GTN).MethodsThis study recruited hydatidiform mole patients who attended the gynecology departments of the affiliated Hospital of Qinghai University and Qinghai Red Cross Hospital,from January 2015 to December 2017.Those patients were given standardized diagnosis and treatment throughout the study period,and visited regularly.A total of 175 patients with hydatidiform mole were finally enrolled in this study.According toβ-hCG levels measured 2 years after curettage,those patients were divided into a malignant group(n=38)and a cured group(n=137).The blood routine testing results on neutrophil(N),lymphocyte(L),and platelet count(PLT)were collected before and after uterine curettage.The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were further derived.We evaluated how those clinical markers could predict the malignant transformation using the area under the curve(AUC)statistic derived from the receiver operating characteristic(ROC)curves.ResultsFor N,NLR,PLR or lgβ-hCG measured before the first curettage,the mean value in the malignant group was significantly higher than that in the cured group(P<0.05).Mean L value in the cured group was significantly higher than that in the malignant group(P<0.05).Among the clinical markers measured before first curettage,for NLR=3.23,PLR=159.38,or their combination,the AUC was estimated as 0.727(P<0.05,95%CI:0.63-0.82),0.675(P<0.05,95%CI:0.58-0.78),or 0.724(P<0.05,95%CI:0.65~0.79),respectively;Among the markers measured after curettage,PLR=129.2,the AUC was 0.636(P<0.05,95%CI:0.56-0.71).ConclusionAmong hydatidiform mole patients,the risk of malignant transformation can be predicted by NLR and PLR before the first curettage,or PLR after curettage.

关 键 词：葡萄胎 清宫前后的NLR及PLR 恶变预测 

分 类 号：R71[医药卫生—妇产科学]