肿瘤并发病原菌感染患者NLR的临床意义

目的 探讨肿瘤患者外周血象中性粒细胞与淋巴细胞数比值（NLR）对肿瘤并发病原菌感染的诊断价值。方法 回顾分析中科院合肥物质研究院肿瘤医院2014年4月至2016年1月收治的43例伴病原菌感染肿瘤患者（感染组）和43例无病原菌感染患者（非感染组）资料，统计学分析两组与健康对照组患者白细胞数（WBC）、中性粒细胞数（NEUT）、淋巴细胞数（LYMPH）、NLR、血红蛋白（Hb）及血清白蛋白（ALB）指标差异及其相关性；采用logistic二分类回归分析肿瘤并发病原菌感染危险因素；ROC曲线分析NLR对肿瘤并发病原菌感染诊断价值。结果 感染组患者的NLR高于非感染组及对照组且非感染组高于对照组，差异均有统计学意义（P=0.000）；感染组WBC及NEUT数均高于非感染组及对照组（P=0.000、P=0.001）但非感染组与对照组比较，差异无统计学意义（P=0.240、P=0.666）；感染组LYMPH、ALB及Hb均低于非感染组及对照组（P=0.000、P=0.000、P=0.003）且非感染组低于对照组（P=0.000、P=0.000、P=0.000）；肿瘤组NLR与其ALB、Hb、淋巴细胞呈负相关（r=-0.530、r=-0.216、r=-0.740，P=0.000、P=0.046、P=0.000），与中性粒细胞正相关（r=0.604，P=0.000）；logistic回归显示，NLR升高及ALB降低是肿瘤患者合并病原菌感染独立危险因素（P=0.001、P=0.023）。ROC曲线显示，NLR的曲线下面积（AUC）为0.864（P=0.000），当NLR取值为4.19、4.62时，NLR诊断感染敏感性为88.39%，83.7%，特异性为69.77%、74.4%，诊断价值最大；NEUT的AUC为0.647（P=0.018）；WBC对感染无诊断价值（P=0.237）。结论 NLR对肿瘤患者发生病原菌感染具有较好诊断效能；NLR与ALB、Hb有相关性。

Clinical significance of NLR detection in tumor patients with pathogens infection

Objective To discuss the diagnostic value of peripheral blood neutrophil-to-lymphocyte ratio (NLR) in the tumor patients with pathogens infection. Methods The clinical data of 43 tumor patients with pathogens infection (the infection group) and 43 tumor patients without pathogens infection (the non-infection group) ever treated in our hospital from Apr 2014 to Jan 2016 were retrospectively analyzed. The variability and correlation of leukocyte count, neutrophils count, lymphocyte count, NLR, hemoglobin (Hb) level and serum albumin (ALB) level in the two groups were statistically analyzed and compared with the healthy controls. The risk factors of pathogens infection in the tumor patients were analyzed by binary logistic regression, and the diagnostic value of NLR in the tumor patients with pathogens infection were evaluated by receiver-operating characteristic (ROC) curves. Results NLR of the infection group was significantly higher than those of the non-infection group and healthy controls, and NLR of the non-infection group was also significantly higher than that of healthy controls (P=0.000). Leukocyte count and neutrophils count of the infection group were significantly higher than those of the non-infection group and healthy controls (P=0.000, P=0.001), while no significant difference was found between the non-infection group and the healthy controls (P=0.240, P=0.666). Lymphocyte count, Hb and ALB levels of the infection group were significantly lower than those of the non-infection group and healthy controls (P=0.000, P=0.000, P=0.003), and those of the non-infection group were also significantly lower than those of healthy controls (P=0.000, P=0.000, P=0.000). NLR of the tumor patients was negatively associated with their serum ALB levels, Hb levels and lymphocyte count (r=-0.530, r=-0.216, r=-0.740; P=0.000, P=0.046, P=0.000), and was positively associated with their neutrophils count (r=0.604, P=0.000). Logistic regression analysis showed that the increase of NLR and the decrease of ALB were independent risk factors of the tumor patients with pathogens infection (P=0.001, P=0.023). ROC curves resulted that area under the curve (AUC) of NLR was 0.864 (P=0.000), and when the NLR value being 4.19 and 4.62, the NLR sensitivity of infection diagnosis were 88.39% and 83.7%, the NLR specificity were 69.77% and 74.4%, respectively, with the best diagnostic value. The AUC of neutrophils count was 0.647 (P=0.018), and the leukocyte count showed no diagnostic value for infection (P=0.237). Conclusion The peripheral blood NLR shows diagnositic value in the tumor patients with pathogens infection, and it also has correlation with the ALB and Hb levels.