实体肿瘤化疗中不同程度骨髓抑制患者的炎症相关指标变化及价值分析  

Analysis of changes and clinical value of inflammatory derived indices related to myelosuppression caused by chemotherapy in patients with solid tumors

作　　者：张宇晴[1] 刘志强[2] 喻信林 张黎明 徐优慧[3] ZHANG Yuqing;LIU Zhiqiang;YU Xinlin;ZHANG Liming;XU Youhui(Department of Medical Laboratory,Jiangxi Cancer Hospital,Nanchang,Jiangxi 330000,China;Department of Clinical Laboratory,Jiangxi Provincial Children’s Hospital,Nanchang,Jiangxi 330006,China;Department of Pathology,Jiangxi University of Chinese Medicine,Nanchang,Jiangxi 330004,China)

机构地区：[1]江西省肿瘤医院医学检验科,南昌330000 [2]江西省儿童医院医学检验科,南昌330006 [3]江西中医药大学病理教研室,南昌330004

出　　处：《重庆医学》2025年第4期852-857,862,共7页Chongqing Medical Journal

基　　金：江西省卫生健康委员会科技计划项目(202310889);江西省卫生健康委员会中医药科研课题(2015A037);江西省肿瘤医院-科研(KFJJ2023YB17)。

摘　　要：目的探讨实体肿瘤化疗过程中不同程度骨髓抑制患者的炎症相关指标变化情况。方法回顾性分析2022年1月至2023年8月于江西省肿瘤医院接受化疗的189例恶性肿瘤患者的临床资料,根据骨髓抑制分级情况分为0度(n=35)、Ⅰ度(n=23)、Ⅱ度(n=31)、Ⅲ度(n=21)、Ⅳ度非感染(n=51)、Ⅳ度感染(n=28)。收集并比较各骨髓抑制程度患者炎症指标[单核细胞(MO)、淋巴细胞(LY)]、网织红细胞(RET)、前白蛋白(PA)和白蛋白(ALB)、炎症感染指标[C反应蛋白(CRP)和血清淀粉样蛋白A(SAA)]及复合衍生炎症指数[中性粒细胞与淋巴细胞比值(NLR)、系统性免疫炎症指数(SII)、系统性炎症反应指数(SIRI)、淋巴细胞与C反应蛋白比值(LCR)、C反应蛋白与白蛋白比值(CAR)]水平,分析各指标与骨髓抑制积分的相关性,并采用多因素logistic回归分析肿瘤患者化疗后骨髓抑制的影响因素。结果随着骨髓抑制程度加重,MO、LY、SII、SIRI、LCR水平逐渐降低,呈现下降趋势(P<0.05);而CRP、SAA、CAR水平逐渐升高,呈现上升趋势(P<0.05)。达Ⅲ度及以上骨髓抑制时,RET、PA水平降低(P<0.05);达Ⅳ度及以上骨髓抑制时,NLR水平降低(P<0.05)。CRP、SAA和CAR与骨髓抑制程度呈正相关,MO、LY、RET、PA、NLR、SII、SIRI、LCR与骨髓抑制程度呈负相关(P<0.05)。多因素logistic回归分析结果显示,LY、NLR是肿瘤患者化疗导致骨髓抑制的影响因素(P<0.05)。结论实体肿瘤化疗导致骨髓抑制后可致机体抗肿瘤免疫能力不断下降,深度骨髓抑制对患者预后不利,感染可促进肿瘤发展导致不良预后。Objective To investigate the changes and clinical value of inflammatory derived indices related to myelosuppression caused by chemotherapy in patients with solid tumors.Methods The clinical data of 189 patients with malignant tumor who received chemotherapy in Jiangxi Cancer Hospital from January 2022 to August 2023 were retrospectively analyzed.According to the grade of myelosuppression,they were divided into 0 degree(n=35),Ⅰdegree(n=23),Ⅱdegree(n=31),Ⅲdegree(n=21),Ⅳdegree non-infection(n=51)andⅣdegree infection(n=28).The levels of inflammatory index[monocyte(MO),lymphocyte(LY)],reticulocyte(RET),prealbumin(PA),albumin(ALB),inflammatory infection index[C reactive protein(CRP)and serum amyloid A(SAA)]and complex derived inflammatory index[neutrophil to lymphocyte ratio(NLR),systemic immunoinflammatory index(SII),systemic inflammatory response index(SIRI),lymphocyte to C reactive protein ratio(LCR),C reactive protein to albumin ratio(CAR)]were collected and compared in patients with different degrees of myelosuppression.The correlation between each index and myelosuppression score was analyzed,and the influencing factors of myelosuppression after chemotherapy in tumor patients were analyzed by multivariate logistic regression.Results With the severity of myelosuppression,the levels of MO,LY,SII,SIRI and LCR decreased gradually and showed a downward trend(P<0.05).The levels of CRP,SAA and CAR were increased gradually(P<0.05).RET and PA levels were decreased when myelopathic depression reachedⅢdegree or above(P<0.05).When myelosuppression reached gradeⅣand above,the level of NLR decreased(P<0.05).CRP,SAA and CAR were positively correlated with myelosuppression degree,while MO,LY,RET,PA,NLR,SII,SIRI and LCR were negatively correlated with myelosuppression degree(P<0.05).The results of multivariate logistic regression analysis showed that LY and NLR were the influencing factors of myelosuppression caused by chemotherapy in tumor patients(P<0.05).Conclusion Myelosuppression caused by solid tumor chemother

关 键 词：肿瘤 化疗 骨髓抑制 炎症指标 炎症感染指标 复合衍生炎症指数 

分 类 号：R730.53[医药卫生—肿瘤]