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中华细胞与干细胞杂志(电子版) ›› 2019, Vol. 09 ›› Issue (03) : 149 -153. doi: 10.3877/cma.j.issn.2095-1221.2019.03.004

所属专题： 专题评论； 文献；

论著

外周血MDSC水平及NLR、PLR比值对结直肠癌患者临床预后评估的价值
李奕建1,†(), 钟世彪2, 陈利生3   
  1. 1. 532200　崇左，广西崇左市人民医院普外科
    2. 530021　南宁，广西民族医院肛肠科
    3. 530021　南宁，广西医科大学第一附属医院结直肠肛门外科
  • 收稿日期:2019-04-29 出版日期:2019-06-01
  • 通信作者: 李奕建
  • 基金资助:
    崇左重点研发计划(崇科FA2018021)

Value of MDSC level and NLR/PLR ratio in peripheral blood of patients with colorectal cancer in guiding clinical prognosis evaluation

Yijian Li1,†(), Shibiao Zhong2, Shengchen Li3   

  1. 1. General Surgery, People's Hospital of Guangxi Chongzuo City, Chongzuo 532200, China
    2. Guangxi National Hospital Anorectal, Nanning 530021, China
    3. Department of Colorectal and Anal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
  • Received:2019-04-29 Published:2019-06-01
  • Corresponding author: Yijian Li
  • About author:
    Corresponding author: Li Yijian, Email:
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李奕建, 钟世彪, 陈利生. 外周血MDSC水平及NLR、PLR比值对结直肠癌患者临床预后评估的价值[J/OL]. 中华细胞与干细胞杂志(电子版), 2019, 09(03): 149-153.

Yijian Li, Shibiao Zhong, Shengchen Li. Value of MDSC level and NLR/PLR ratio in peripheral blood of patients with colorectal cancer in guiding clinical prognosis evaluation[J/OL]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2019, 09(03): 149-153.

目的

探讨结直肠癌患者外周血髓源抑制细胞（MDSC）水平及中性粒细胞淋巴细胞比值（NLR）、血小板淋巴细胞比值（PLR）对临床预后评估的价值。

方法

选取广西崇左市人民医院普外科2013年5月至2018年5月收治的183例结直肠癌患者及50名健康体检者，分别纳入患者组、对照组。检测患者组治疗前、对照组入组时外周血MDSC水平及NLR、PLR比值，记录患者组治疗前、治疗后1个月上述指标变化，并比较治疗有效、无效患者治疗前上述指标的差异。采用卡方检验、t检验及受试者工作特征曲线（ROC）进行统计学分析。

结果

患者组治疗前MDSC比例及NLR、PLR比值分别为（4.26±0.99）﹪、3.05±0.59、146.45±29.71，均高于对照组的（0.71±0.15）﹪、1.62±0.37、90.92±13.88，差异具有统计学意义（t?= 25.238、16.272、12.824，P均< 0.05）。患者治疗后1个月MDSC比例及NLR、PLR比值均较治疗前下降，差异具有统计学意义（P均< 0.05）。183例患者中，111例肿瘤未进展，纳入治疗有效组，72例肿瘤进展，纳入治疗无效组。治疗有效组治疗前MDSC比例及NLR、PLR比值分别为（4.06±0.61）﹪、2.73±0.40、136.18±26.11，均低于治疗无效组的（4.57±0.42）﹪、3.54±0.31、162.29±18.64，差异具有统计学意义（t?= 6.202、14.572、7.353，P均< 0.05）。ROC曲线示，以治疗前MDSC≥4.22﹪、NLR≥3.21、PLR≥151.60为截断值，MDSC比例联合NLR、PLR比值预测结直肠癌患者治疗无效的曲线下面积为0.909（P < 0.05）。

结论

结直肠癌患者外周血MDSC水平及NLR、PLR比值升高，且较高的MDSC水平及NLR、PLR比值意味着预后不良。

关键词: 结直肠癌, 髓源抑制细胞, 中性粒细胞/淋巴细胞比值, 血小板/淋巴细胞比值, 预后评估
Objective

To explore the value of Myeloid-derived suppressor cell (MDSC) level in peripheral blood, neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in guiding clinical prognosis evaluation of patients with colorectal cancer.

Methods

183 patients with colorectal cancer and 50 health examinees admitted to our hospital from May 2013 to May 2018 were enrolled in the patient group and the control group respectively. The levels of MDSC and the ratio of NLR to PLR in peripheral blood of patients before and after treatment were measured. The changes of the above indexes in patients before and after treatment were recorded, and the differences of the above indexes in patients with effective and ineffective treatment before treatment were compared. Chi-square test, t-test and receiver operating characteristic (ROC) were used for statistical analysis.

Results

Before treatment, the ratio of MDSC, NLR and PLR in patients group were (4.26±0.99) ﹪, (3.05±0.59) , (146.45±29.71) respectively, which were higher than those in the control group (0.71 ±0.15) ﹪, (1.62 ±0.37) , (90.92 ±13.88) . The difference was statistically significant (t?= 25.238, 16.272, 12.824, P all < 0.05) . The ratio of MDSC, NLR and PLR decreased one month after treatment, and the difference was statistically significant (P < 0.05) . Among 183 patients, 111 cases were included in the effective treatment group and 72 cases were included in the ineffective treatment group. The ratio of MDSC, NLR and PLR in the effective group before treatment were (4.06±0.61) ﹪, (2.73±0.40) , (136.18±26.11) , respectively, which were lower than those in the ineffective group (4.57±0.42) ﹪, (3.54±0.31) , (162.29±18.64) , respectively (t?= 6.202, 14.572, 7.353, P all < 0.05) . ROC curve showed that the area under the curve of MDSC (> = 4.22﹪) , NLR (> = 3.21) , PLR (> = 151.60) before treatment was 0.909 (P < 0.05) .

Conclusion

The level of MDSC and the ratio of NLR to PLR of the peripheral blood in patients with colorectal cancer are significantly increased, and the higher MDSC level and the ratio of NLR to PLR imply poor prognosis.

Key words: Colorectal cancer, Myelogenous suppressor cells, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio, Prognostic evaluation
表1 患者组与对照组检测结果比较（±s）
分组 例数 MDSC（﹪） NLR PLR
患者组 183 4.26±0.99 3.05±0.59 146.45±29.71
对照组 50 0.71±0.15 1.62±0.37 90.92±13.88
t值 ? 25.238 16.272 12.824
P值 ? < 0.01 < 0.01 < 0.01
表2 患者治疗前后检测结果比较（±s）
时期 例数 MDSC（﹪） NLR PLR
治疗前 183 4.26±0.99 3.05±0.59 146.45±29.71
治疗后1个月 183 2.28±0.42 2.27±0.39 118.65±25.30
t值 ? 24.907 14.919 9.637
P值 ? < 0.01 < 0.01 < 0.01
表3 治疗有效组与治疗无效组治疗前检测结果比较（±s）
时期 例数 MDSC（﹪） NLR PLR
治疗有效组 111 4.06±0.61 2.73±0.40 136.18±26.11
治疗无效组 72 4.57±0.42 3.54±0.31 162.29±18.64
t值 ? 6.202 14.572 7.353
P值 ? < 0.01 < 0.01 < 0.01
表4 MDSC、NLR、PLR单独及联合评估结直肠癌患者治疗无效的效能分析
指标 截断值 灵敏度（﹪） 特异性（﹪） 曲线下面积
MDSC ≥4.22﹪ 87.90 86.82 0.881
NLR ≥3.21 85.06 87.99 0.878
PLR ≥151.60 81.74 85.06 0.824
MDSC＋NLR＋PLR ? 90.13 88.25 0.909
图1 MDSC比例及NLR、PLR比值预测结直肠癌患者治疗无效的ROC曲线
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