中性粒细胞与淋巴细胞比值早期预测直肠癌术后吻合口瘘的价值

目的探讨中性粒细胞与淋巴细胞比值(NLR)在早期预测直肠癌术后吻合口瘘中的临床价值。方法收集2014年1月至2017年12月就诊于郑州大学附属肿瘤医院普外科、行直肠癌根治术的787例患者的临床资料。患者于术后第1、3、5天分别检测血常规,记录白细胞计数(WBC),计算NLR。分析术后第1、3、5天NLR与吻合口瘘的关系,绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC),评价术后NLR预测吻合口瘘的准确率。结果术后第1、3、5天,吻合口瘘患者的平均WBC分别为13.2×10^9/L、9.1×10^9/L和8.9×10^9/L,吻合口愈合患者的平均WBC分别为12.9×10^9/L、9.0×10^9/L和8.8×10^9/L,差异无统计学意义(P>0.05)。术后第1天,吻合口瘘和吻合口愈合患者的平均NLR分别为13.3和11.6,差异无统计学意义(P=0.364);吻合口瘘患者术后第3、5天的平均NLR分别为10.9和7.6,吻合口愈合患者术后第3、5天的平均NLR分别为9.3和5.3,差异有统计学意义(P<0.05)。ROC曲线显示,术后第3天NLR截点值为8.6时,预测直肠癌术后吻合口瘘的灵敏度为73.2%,特异度为75.6%,AUC为0.744。术后第5天NLR截点值为5.5时,预测直肠癌术后吻合口瘘的灵敏度为69.6%,特异度为75.5%,AUC为0.726。多因素分析显示,术后第3天NLR为预测直肠癌术后吻合口瘘的独立因素。结论术后第3天NLR可以较为准确地预测直肠癌术后吻合口瘘的发生,有助于早期发现吻合口瘘,减少吻合口瘘导致的并发症。

The clinical values of neutrophil-to-lymphocyte ratio as an early predictor of anastomotic leak in postoperative rectal cancer patients

Objective To assess the clinical value of neutrophil-to-lymphocyte ratio(NLR)in predicting anastomotic leak of postoperative rectal cancer patients.Methods The clinical data of 787 rectal cancer patients who underwent anterior resection from January 2014 to December 2017 in Affiliated Tumor Hospital of Zhengzhou University were collected.The postoperative numbers of white blood cell(WBS)on postoperative day(POD)1,3 and 5 were detected,and the NLR was calculated.The relationship of NLR and the incidence of anastomotic leak was analyzed,and the area under the receiver-operating characteristic(ROC)curves was calculated.The accuracy of postoperative NLR in predicting the incidence of anastomotic leak was evaluated.Results WBC counts of patients with leak on POD1,POD3 and POD5 were 13.2×10^9/L,9.1×10^9/L and 8.9×10^9/L,respectively,while those of patients without leak were 12.9×10^9/L,9.0×10^9/L and 8.8×10^9/L.The WBC count was not significantly different between patients with or without leak(P>0.05).The average NLR values of patients with or without leak were 13.3 and 11.6 on POD1,10.9 and 7.6 on POD3,9.3 and 5.3 on POD5,respectively.The NLR values of patients with leak on POD3 and POD5 were significantly higher than those of patients without leak(P<0.05).The cutoff value of NLR on POD3 was 8.6,the sensitivity and specificity of detecting the leakage was 73.2% and 75.6%,respectively,and the area under curve(AUC)was 0.744.The cutoff value of NLR on POD5 was 5.5,the sensitivity and specificity was 69.6%and 75.5%,the AUC was 0.726.The multivariate analysis result showed that NLR>8.6 was an independent factor for anastomotic leak prediction.Conclusion Postoperative NLR on day 3 is useful in predicting anastomotic leak and can decrease the incidence of complication in rectal cancer patients who underwent anterior resection.