目的 评估中性粒细胞与淋巴细胞比值(NLR)在晚期结直肠癌(CRC)患者化疗疗效及预后的意义。方法 回顾性收集2016年1月—2019年4月期间接受以奥沙利铂为基础的标准一线化疗的晚期不可切除结直肠癌患者50例临床病历资料,并在2个化疗周期后评估化疗疗效;根据入组患者化疗前血液学数据计算中性粒细胞与淋巴细胞比值(NLR),运用受试者工作特征曲线确定的NLR最佳截断值,将患者分为高NLR(≥3.785) 组和低NLR(＜3.785) 组,比较高、低NLR与临床病理特征、化疗疗效及无进展生存期(PFS)、总生存期(OS)差异;采用COX回归分析模型分析影响晚期结直肠癌患者PFS、OS的因素。结果 高、低NLR两组肿瘤分化程度(P=0.030)、ECOG评分(P=0.003)、CEA(P=0.011)、CA19-9(P=0.047)比较,差异有统计学意义;高低NLR两组间化疗疗效比较,差异有统计学意义(P＜0.001),高NLR组化疗疗效较差;两组中位PFS分别为3.44个月和12.84个月,差异有统计学意义(χ²=39.730,P＜0.001),两组中位OS分别为7.59个月和22.32个月,差异有统计学意义(χ²=40.505,P＜0.001);Cox回归分析提示NLR高低、CEA水平是PFS、OS的独立预后因素(P＜0.05)。结论 高水平NLR与晚期结直肠癌患者化疗疗效不佳和预后不良相关,可作为其化疗疗效及预后监测的指标。

Objective To evaluate the value of neutrophil-lymphocyte ratio (NLR) in the chemotherapy curative effect and prognosis of patients with advanced colorectal cancer (CRC). Methods Retrospective collection of clinical data from 50 patients with advanced unresectable colorectal cancer who received oxaliplatin-based standard first-line chemotherapy between January 2016 and April 2019. Chemotherapy curative effect was evaluated following 2 chemotherapy cycles. Calculation of neutrophil to lymphocyte ratio (NLR) based on pre-chemotherapy hematology data. The receiver operating characteristic curve was used to determine the optimal cutoff value of NLR,according to patients who were divided into groups of high NLR(NLR≥3.785)and low NLR(NLR≥3.785).The differences between high and low NLR and clinicopathological features, efficacy of chemotherapy, progression-free survival (PFS), and total survival (OS) were compared. COX regression analysis mode was used to analysis of factors affecting PFS and OS in patients with advanced colorectal cancer. Results The differences in tumor differentiation (P=0.030), ECOG score (P=0.003), CEA (P=0.011), CA19-9 (P=0.047) in the high and low NLR groups were statistically significant. The differences in chemotherapy between the two groups was statistically significant (P<0.001), and the high NLR group was less effective. The median PFS of the high and low NLR groups were 3.44 months and 12.84 months, respectively, and the difference was statistically significant (χ²=39.730, P<0.001). The median OS of the high and low NLR groups was 7.59 months and 22.32 months, respectively, and the difference was statistically significant (χ²=40.505, P<0.001). Cox regression analysis suggested that NLR levels and CEA levels were independent prognostic factors for PFS and OS(P＜0.05). Conclusion High-level NLR is associated with poor chemotherapy response and poor prognosis in patients with advanced colorectal cancer, and was used as an indicator of chemotherapy efficacy and prognosis.

目的 探讨C反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞计数(NC)及中性粒细胞/淋巴细胞比值(NLR)在肺癌患者化疗后合并细菌感染早期诊断中的意义。方法 收集本院肿瘤科2019年1月—2019年12月肺癌化疗后合并细菌感染患者78例,肺癌化疗后未感染患者64 例,同期健康体检人群39例,采用固相免疫色谱法和速率散射比浊法测定血清中的PCT及CRP 的含量,采用mindray cal8000血细胞分析仪进行血细胞分类计数检查,计算N及NLR。结果 化疗后感染组CRP、PCT、NC及NLR均高于化疗未感染组及健康对照组,差异均有统计学意义(P＜0.01);化疗未感染组与健康对照组CRP、PCT、NC及NLR差异有统计学意义(P＜0.01)。CRP、PCT、NC及NLR联合使用时,其灵敏度为97.507%,而特异度升高为97.15%。细菌感染患者治疗前的PCT、CRP、NC及NLR 与治疗后相比较差异有统计学意义(P<0.05),治疗后低于治疗前。结论 PCT、CRP、NC及NLR联合检测能够提高对肺癌患者化疗后合并细菌感染早期诊断的敏感度和特异度。

Objective To explore the significance of C-reactive protein (CRP), procalcitonin (PCT), neutrophil count (NC) and neutrophil / lymphocyte ratio (NLR) in the early diagnosis of bacterial infection in lung cancer patients after chemotherapy. Methods From January 2019 to December 2019, 78 cases of lung cancer patients with bacterial infection after chemotherapy, 64 cases of uninfected patients after chemotherapy and 39 cases of healthy people in the same period were collected. the contents of PCT and CRP in serum were detected by solid phase immunosorbent assay and rate nephelometry.The NC and NLR were classified and counted by mindray cal8000 hematology analyzer. Results After chemotherapy, CRP, PCT, NC and NLR in the infected group were higher than those in the uninfected group and the healthy control group (P<0.01), while CRP, PCT, NC and NLR in the uninfected group were higher than those in the healthy control group (P<0.01). When CRP, PCT, NC and NLR were used together, the sensitivity was 97.507%, while the specificity increased by 97.15%. The PCT, CRP, NC and NLR of patients with bacterial infection before treatment were lower than those after treatment (P<0.05). Conclusion PCT, CRP, NC and NLR may improve the sensitivity and specificity of early diagnosis of bacterial infection in patients with lung cancer after chemotherapy.

目的 探讨急性心肌梗死患者入院首次中心粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与院内主要不良心血管事件(MACE)发生的相关性。方法 回顾分析2016年1月—2016年12月入住我院的急性心肌梗死患者179例,分为发生院内不良事件组(n=46)和未发生组(n=133)。采用单因素及多因素Logistics回归分析评估NLR与MACE风险的相关性。结果 179例患者中,46例患者发生院内MACE。发生院内MACE组患者的淋巴细胞计数低于未发生组(P<0.05),NLR高于未发生组(P<0.05),发生院内MACE组患者入院时的心、肾功能较未发生组差(P<0.05)。单因素回归分析显示,NLR水平与院内MACE发病率相关(OR=1.079,95%CI:1.014～1.147, P＜0.05)。多因素logistic回归分析校正性别、年龄、高血压病史、糖尿病史、Killip II级以上、收缩压、入院首次白细胞、eGFR、超敏C反应蛋白、左室射血分数及多支病变后显示,NLR是院内MACE的独立危险因素(OR=1.182,95%CI:1.034～1.352,P＜0.05);此外,超敏C反应蛋白及LVEF<50也是院内MACE的独立危险因素(P＜0.05)。结论 入院首次高NLR与急性心肌梗死患者发生院内MACE相关,是患者发生院内MACE的独立危险因素。

Objective To explore the correlation between first neutrophil/lymphocyte ratio(NLR) and in-hospital major adverse cardiac events (MACE) in patients with in patients with acute myocardial infarction. Methods Total of 179 patients with acute myocardial infarction in Guangzhou First People's Hospital from Jan 2016 to Dec 2016 were enrolled. MACE was defined as malignant arrhythmia, recurrence of myocardial infarction, target vascular reconstruction, acute left heart failure, stroke, cardiac shock and death.Baseline data and in-hospital clinical adverse events were compared among two groups. All patients were divided into two groups:MACE(+) group and MACE(-) group. Univariate and multivariate logistic regression was used to assess the correlation between NLR and in-hospital MACE. Results In-hospital MACE occurred in 46(25.7%)patients. Univariate logistic analysis showed that NLR was strongly related with MACE incidence(OR=1.079,95%CI:1.014～1.147, P＜0.05). Multivariate logistic regression analysis found that after adjusting other traditional risk factors including female gender, age, hypertension,diabetes, overKillip II grade, systolic blood pressure,first white blood cells after admitted,basic renal dysfunction,Hs-CRP,LVEF and multivessel lesions. NLR was still a significant independent predictor of in-hospital MACE in patients with acute myocardial infarction. Additionally, hs-CRP and LVEF<50% were also associated with in-hospital MACE(P＜0.05). Conclusion NLR is the independent risk factor for in-hospital MACE occurrence in acute myocardial infarction at the early admission.

目的 探讨血清降钙素原(PCT)与中性粒细胞淋巴细胞比率(NLR)对预测急性胰腺炎(AP)继发急性肺损伤(ALI)的临床适用性。方法 回顾性分析60个AP病例,对合并ALI的实验组和没有合并ALI的对照组治疗前后血清PCT和NLR进行均数比较、相关性分析、ROC分析等统计分析。结果 两组间治疗前NLR(P=0.019)与治疗期间血清PCT平均值(P<0.001)有统计学差异,ROC分析:治疗前NLR、治疗期间血清PCT平均值对于预测ALI的灵敏度、特异度、约登指数分别为0.778、0.889;0.690、0.881;0.468、0.77,两者的差异有统计学意义(P=0.0134)。结论 急性胰腺炎早期治疗前,NLR对于预测ALI有一定的参考价值,而在急性胰腺炎后期,治疗期间的血清PCT平均值对于预测ALI有着良好的灵敏度和特异度,具有一定的临床适用性。

Objective To investigate the clinical applicability of serum procalcitonin levels and neutrophil-to-lymphocyte ratio (NLR) in predicting acute lung injury(ALI) secondary to acute pancreatitis(AP). Methods Sixty cases of AP were recruited to explore their serum-PCT and NLR before/after treatment. Means comparison, correlation analysis, ROC analysis were carried out. Results The NLR before treatment (P=0.019)and serum-PCT after treatment(P<0.001)were statistical significance of two groups(ALI、NON-ALI). In ROC analysis, the sensitivity, specificity, Jorden index of above two index were 0.778、0.889;0.690、0.881;0.468、0.77 respectively. There were statistically significant differences between them(P=0.0134). Conclusion In the early phase before treatment in AP, NLR has certain reference value in predicting ALI. On the other hand, in the later phase after treatment in AP, serum-PCT has great sensitivity, specificity and clinical applicability.