系统免疫炎症指数在早期结直肠癌及癌前病变筛查中的应用价值

目的 本研究探讨不同炎症指标在早期结直肠癌及癌前病变诊断中的应用价值。方法 收集2008年2月至2020年12月在首都医科大学附属北京世纪坛医院消化内镜中心诊断为早期结直肠癌及癌前病变,并完成病变治疗患者的一般资料、实验室检查结果、结肠镜检查结果和其他临床资料,分析炎症指标与早期结直肠癌及癌前病变临床病理特征的相关性。结果 单因素分析结果显示,吸烟史(P =0.006)、病变部位(P =0.000)、病变大小(P =0.000)、病变数目(P =0.004)、病变治疗方式(P =0.000)、中性粒细胞计数(P =0.000)、中性粒细胞－淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)(P =0.000)、系统免疫炎症指数(systemic immune-inflammation index, SII)(P =0.001)与早期结直肠癌和结直肠癌前病变的病理性质相关。多因素Logistic回归分析结果显示,高脂血症病史(P =0.009)、病变部位(P =0.000)、病变大小(P =0.000)、病变数目(P =0.024)、SII(P =0.004)是早期结直肠癌和结直肠癌前病变病理性质的独立影响因素。SII区分两组患者的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.643(95% CI: 0.560 ～ 0.725,P =0.001);当SII为500.27时,其诊断早期结直肠癌的灵敏度为54.9%,特异度为70.7%,但诊断结果与病理结果的一致性较差(Kappa < 0.40)。结论 SII用于早期结直肠癌及癌前病变的筛查,可能有助于内镜医师在行结肠镜时初步判断病变的病理性质。

Application value of systemic immune-inflammation index in the screening of early colorectal cancer and precancerous lesions

Objective To explore the application value of different inflammatory markers in the diagnosis of early colorectal cancer and precancerous lesions. Methods We collected the general data, laboratory examination results, colonoscopy results and other clinical medical records of patients with early colorectal cancer and precancerous lesions in the digestive endoscopy center of our unit from February 2008 to January 2019, and analyzed the correlation between inflammatory markers and clinicopathological characteristics of early colorectal cancer and precancerous lesions. Results The univariate analysis showed that smoking history(P =0.006), lesion location(P =0.000), lesion size(P =0.000), lesion number(P =0.004), lesion treatment method(P =0.000), neutrophil count(P =0.000), NLR(P =0.000), SII(P =0.001)are related to the pathological properties of early colorectal cancer and colorectal precancerous lesions. Multivariate Logistic regression analysis showed that history of hyperlipidemia(P =0.009), lesion location(P =0.000), lesion size(P =0.000), lesion number(P =0.024), SII (P =0.004)are independent predictors of the pathological properties of the two groups of patients, and the area under the ROC curve of SII to distinguish the two groups of patients is 0.643 (95% CI: 0.560－0.725; P=0.001). When the SII is 500.27, its sensitivity for diagnosing early colorectal cancer is 54.9%, and its specificity is 70.7%, but the consistency between the diagnostic results and pathological is poor (Kappa < 0.40). Conclusion The use of SII in the screening of early colorectal cancer and precancerous lesions may be helpful for colonoscopist to diagnose the pathological types.