中性粒细胞、单核细胞和淋巴细胞对不同级别胶质瘤预后的评估价值

目的探讨术前外周血中性粒细胞与淋巴细胞比(neutrophil-lymphocyte radio,NLR)与单核细胞计数/淋巴细胞计数比(monocyte-tolymphocyte ratio,MLR)对不同级别胶质瘤患者预后的评估价值.方法本研究纳入2010年1月至2018年3月期间在哈尔滨医科大学附属第三医院神经外科接受手术的635名胶质瘤患者,其中低级别胶质瘤296例,高级别胶质瘤344例,收集其临床病历资料以及随访资料.通过R统计分析软件确定NLR、MLR对胶质瘤预后作用的最佳分界点,并以最佳分界点为界值对纳入研究对象进行分组.采用Kaplan-Meier生存分析、单因素和多因素Cox回归分析,评估术前外周血NLR、MLR对不同级别胶质瘤患者的预后的影响.结果高级别与低级别胶质瘤患者的术前NLR、MLR水平不同.NLR、MLR对胶质瘤预后影响的最佳分界点分别为1.83和0.16.在低级别与高级别胶质瘤中,NLR<1.83患者的中位生存期均大于NLR≥1.83患者,MLR<0.16患者的中位生存期均大于MLR≥0.16患者.在低级别胶质瘤中,NLR,MLR均是预后影响因素,其中高NLR是低级别胶质瘤预后的独立危险因素[OR=1.92(1.14~3.23),P<0.05];在高级别胶质瘤中,仅高NLR是胶质瘤患者预后的危险因素,且为独立危险因素[OR=1.42(1.05~1.93),P<0.05].结论NLR、MLR可以作为低级别胶质瘤患者预后的临床评估指标,仅NLR可作为高级别胶质瘤患者预后的临床评估指标.相比较MLR,NLR是更有效的胶质瘤患者预后的临床评估指标.

Evaluation value of neutrophil,monocyte and lymphocyte for the prognosis of different grade glioma

Objective To evaluate the prognostic value of neutrophil-lymphocyte radio(NLR),monocyte-tolymphocyte ratio(MLR)for the prognosis of different grades glioma.Methods We enrolled 635 glioma patients who received surgery from January 2010 to March 2018 in the Neurosurgery Department,the Third Affiliated Hospital of Harbin Medical University,with 291 low-grade gliomas and 344 high-grade gliomas,and collected their clinical records and follow-up data.The optimal cut-off values of NLR and MLR for the prognosis of gliomas was determined by R software.The patients were divided into high-value groups and low-value groups according to the cut-off values.Kaplan-Meier survival analysis,univariate and multivariate Cox regression analysis were used to evaluate the effect of preoperative peripheral blood NLR and MLR on the prognosis of patients with different grade gliomas.Results The preoperative NLR and MLR levels were statistical different between low-grade and high-grade gliomas.The best cut-off points for the effects of NLR and MLR on the prognosis of glioma were 1.83 and 0.16,respectively.In low-grade and high-grade gliomas,the median survival of patients with NLR<1.83 was greater than that of NLR≥1.83,and the median survival of patients with MLR<0.16 was greater than that of MLR≥0.16.In low-grade gliomas,NLR and MLR were prognostic risk factors,and NLR was an independent risk factor of glioma prognosis[OR=1.92(1.14~3.23),P<0.05].In high-grade gliomas,only NLR was independent risk factor of glioma prognosis[OR=1.42(1.05~1.93),P<0.05].Conclusion Preoperative blood NLR and MLR can be used as clinical evaluation indicators for low-grade glioma prognosis,and only NLR was the clinical evaluation indicator for high-grade glioma prognosis.NLR was more effective prognostic indicator for glioma patients than MLR.