外周血NLR、PLR及血清LDH对小细胞肺癌患者发生放射性肺炎的预测价值  

Value of peripheral blood NLR,PLR and serum LDH for predicting the occurence of radiation pneumonia in patients with small cell lung cancer

作　　者：李莹 陈仔含 冯志婧 陆昭雪 张旭光 Li Ying;Chen Zihan;Feng Zhijing;Lu Zhaoxue;Zhang Xuguang(Graduate School of Xuzhou Medical University,Xuzhou 221004,Jiangsu Province,China;Department of Radiotherapy,Xuzhou Cancer Hospital,Xuzhou 221005,Jiangsu Province,China;Department of Medical Oncology,Xuzhou Cancer Hospital,Xuzhou 221005,Jiangsu Province,China)

机构地区：[1]徐州医科大学研究生学院,徐州221004 [2]徐州市肿瘤医院放疗科,徐州221005 [3]徐州市肿瘤医院肿瘤内科,徐州221005

出　　处：《中国基层医药》2024年第3期321-326,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：江苏省自然科学基金(BK20151156)。

摘　　要：目的探讨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)和血清乳酸脱氢酶(LDH)水平对小细胞肺癌患者发生放射性肺炎(RP)的预测价值。方法回顾性分析徐州市肿瘤医院2019年9月至2022年9月治疗的小细胞肺癌患者84例的临床资料,患者均采用图像引导下放射治疗。根据是否发生RP将其分为RP组25例与非RP组59例,比较两组放疗开始前和放疗后外周血NLR、PLR及血清LDH水平,采用受试者工作特征曲线(ROC曲线)分析外周血NLR、PLR及血清LDH单独和联合检测对小细胞肺癌发生RP的诊断价值。结果放疗前,两组外周血NLR和PLR值差异均无统计学意义(均P>0.05)。放疗后,RP组外周血NLR(3.39±0.81)、PLR(129.06±24.90)均明显高于非RP组的(2.54±0.71)、(104.76±26.26),差异均有统计学意义(t=3.61、3.83,均P<0.05)。RP组患者中分级为2级的NLR(2.86±0.30)和PLR(110.07±10.05)最低,分级为4级的NLR(4.49±0.63)和PLR(168.88±14.11)最高,RP级别与外周血NLR、PLR呈正相关。外周血NLR对RP的诊断灵敏度为88.0%,特异度为66.1%,曲线下面积(AUC)为0.791;PLR对RP的诊断灵敏度为48.0%,特异度为94.9%,AUC为0.735;NLR联合PLR对RP的诊断灵敏度为92.0%,特异度为59.3%,AUC为0.801。两组放疗前后血清LDH差异均无统计学意义(均P>0.05)。logistic回归分析表明,NLR、PLR为小细胞肺癌患者发生RP的危险因素(OR=2.309、1.037;95%CI分别为1.061~5.024、1.004~1.071)。结论发生RP的小细胞肺癌患者,其外周血中的NLR和PLR明显升高,两者联合检测对早期诊断小细胞肺癌的RP有很高的价值。Objective To investigate the value of peripheral blood neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and serum lactate dehydrogenase(LDH)levels for predicting the occurrence of radiation pneumonia(RP)in small cell lung cancer.Methods A total of 84 patients with small cell lung cancer who received image-guided radiotherapy in Xuzhou Cancer Hospital between September 2019 and September 2022 were retrospectively analyzed.They were divided into an RP group(n=25)and a non-RP group(n=59)according to whether RP occurred.Peripheral blood NLR and PLR and serum LDH levels were compared between the two groups before and after radiotherapy.The receiver operating characteristic curve(ROC curve)was used to analyze the value of peripheral blood NLR,PLR,and serum LDH levels for the diagnosis of RP in small cell lung cancer.Results Before radiotherapy,there were no significant differences in peripheral blood NLR and PLR between the two groups(both P>0.05).After radiotherapy,peripheral blood NLR and PLR in the RP group were(3.39±0.81)and(129.06±24.90),respectively,which were significantly higher than those in the non-RP group[(2.54±0.71),(104.76±26.26),t=3.61,3.83,both P<0.05].The NLR(2.86±0.30)and PLR(110.07±10.05)were the lowest in patients with grade 2 RP and they were highest in patients with grade 4 RP[(4.49±0.63),(168.88±14.11)].The grade of RP was positively correlated with peripheral blood NLR and PLR.The sensitivity of peripheral blood NLR in the diagnosis of RP was 88.0%,the specificity was 66.1%,and the area under the curve(AUC)was 0.791.The sensitivity of PLR in the diagnosis of RP was 48.0%,the specificity was 94.9%,and the AUC was 0.735.The sensitivity of NLR combined with PLR in the diagnosis of RP was 92.0%,the specificity was 59.3%,and the AUC was 0.801.There was no significant difference in serum LDH levels between the two groups before and after radiotherapy(both P>0.05).Logistic regression analysis showed that NLR and PLR were risk factors for RP in patients with small cell lung c

关 键 词：癌 非小细胞肺 放射疗法 辐射性肺炎 粒细胞 淋巴细胞 血小板 L-乳酸脱氢酶 预测 

分 类 号：R734.2[医药卫生—肿瘤]