放化疗前血红蛋白/血小板比值、C-反应蛋白/白蛋白比值与局部晚期鼻咽癌患者同步放化疗发生放射性骨坏死关系研究  

Relationship between hemoglobin-to-platelet ratio,C-reactive protein to albumin ratio before chemoradiation and osteoradionecrosis in patients with locoregionally advanced nasopharyngeal carcinoma after concurrent chemoradiotherapy

作　　者：吴霞 刘祥燕 雍小梅 晏晴艳 蒋朝阳 WU Xia;LIU Xiangyan;YONG Xiaomei;YAN Qingyan;JIANG Chaoyang(Department of Oncology,Western Theater Command General Hospital of PLA,Chengdu 610083,China)

机构地区：[1]解放军西部战区总医院肿瘤科,四川成都610083

出　　处：《陕西医学杂志》2024年第5期632-636,共5页Shaanxi Medical Journal

基　　金：四川省卫生健康委员会医学科技项目(21PJ068)。

摘　　要：目的:探讨放化疗前血红蛋白/血小板比值(HPR)、C-反应蛋白/白蛋白比值(CAR)与局部晚期鼻咽癌(LA-NPC)患者同步放化疗(CCRT)发生放射性骨坏死(ORN)的关系。方法:选取接受CCRT治疗的LA-NPC患者457例,CCRT前检测并计算HPR和CAR,CCRT后定期随访,统计ORN发生情况。根据是否发生ORN将患者分为ORN组(33例)和无ORN组(418例)。多因素Logistic回归分析LA-NPC患者CCRT后发生ORN的影响因素。绘制受试者工作特征(ROC)曲线分析HPR和CAR对LA-NPC患者CCRT后发生ORN的预测价值。结果:457例患者失访6例,451例患者中33例发生ORN,ORN发生率为7.32%。ORN组TNM分期为ⅣA期、颅底侵犯、CCRT前或后拔牙、既往有牙科疾病、口腔卫生状况不佳比例高于无ORN组(均P<0.05)。ORN组HPR低于无ORN组,CAR高于无ORN组(均P<0.05)。CCRT前或后拔牙、口腔卫生状况、CAR及HPR是LA-NPC患者CCRT后发生ORN的独立影响因素(均P<0.05)。HPR和CAR两者联合预测LA-NPC患者CCRT后发生ORN的AUC高于两者单独预测AUC(均P<0.05)。结论:CCRT后发生ORN的LA-NPC患者CCRT前HPR降低,CAR增高,两者与LA-NPC患者CCRT后发生ORN有关,对CCRT后ORN发生具有一定预测价值。Objective:To investigate the relationship between hemoglobin-to-platelet ratio(HPR),C-reactive protein to albumin ratio(CAR)before chemoradiation and osteoradionecrosis(ORN)in patients with locoregionally advanced nasopharyngeal carcinoma(LA-NPC)after concurrent chemoradiotherapy(CCRT).Methods:A total of 457 LA-NPC patients receiving CCRT were selected.HPR and CAR were detected and calculated before CCRT,and the incidence of ORN was analyzed by regular follow-up after CCRT.Patients were divided into ORN group(33 cases)and non-ORN group(418 cases)according to whether ORN occurred.Multivariate Logistic regression was used to analyze the influencing factors of ORN after CCRT in LA-NPC patients.Receiver operating characteristic(ROC)curves were drawn to analyze the predictive value of HPR and CAR in the development of ORN after CCRT in LA-NPC patients.Results:Of the 457 patients,6 were lost to follow-up,and 33 of the 451 patients developed ORN,with an incidence of 7.32%.The proportion of TNM stageⅣA,skull base invasion,tooth extraction before or after CCRT,previous dental disease and poor oral health in ORN group was higher than that in non-ORN group(all P<0.05).HPR in ORN group was lower than that in non-ORN group,and CAR in ORN group was higher than that in non-ORN group(all P<0.05).Tooth extraction before or after CCRT,oral hygiene,CAR and HPR were independent factors for the occurrence of ORN after CCRT in LA-NPC patients(all P<0.05).The AUC predicted by HPR and CAR in LA-NPC patients with ORN after CCRT was higher than that predicted by HPR and CAR alone(all P<0.05).Conclusion:Low HPR and high CAR before CCRT are associated with the development of ORN after CCRT in LA-NPC patients,and both of them have a certain predictive value for the occurrence of ORN after CCRT.

关 键 词：局部晚期鼻咽癌 同步放化疗 放射性骨坏死 血红蛋白/血小板比值 C-反应蛋白/白蛋白比值 预测价值 

分 类 号：R739.6[医药卫生—肿瘤]