术前NLR水平与原发性肝癌患者肝切除术后肝衰竭的相关性

摘要/Abstract

摘要： 目的分析原发性肝癌肝切除患者术前中性粒细胞/淋巴细胞比值(NLR)与术后肝衰竭的关系,指导未来对原发性肝癌患者肝切除术后肝衰竭的风险预测及防治。方法回顾性分析,收集2017年3月至2019年11月期间新疆医科大学第一附属医院完成肝切除术治疗与术后随访的274例原发性肝癌患者作为肝癌组,并收集同期医院完成治疗与随访并经组织病理证实为肝脏良性肿瘤的67例患者作为对照组,术前检测并比较两组患者中性粒细胞(NE)、淋巴细胞(LY)及NLR水平;根据肝癌组患者术后是否发生肝衰竭分为发生肝衰竭组与未发生肝衰竭组,对比两组术前NE、LY及NLR水平,检验术前NLR水平对原发性肝癌患者肝切除术后肝衰竭的影响,绘制受试者操作特征(ROC)曲线检验术前NLR水平预测原发性肝癌肝切除术后肝衰竭风险的价值。结果肝癌组术前NE及NLR水平均高于对照组,LY水平低于对照组,差异有统计学意义(P<0.05);274例原发性肝癌患者中,肝切除术后发生肝衰竭的患者有32例,发生率为11.68%;发生肝衰竭组术前NE、NLR水平均高于未发生肝衰竭组,LY水平低于未发生肝衰竭组,差异有统计学意义(P<0.05);经二元Logistic回归分析结果显示,术前NLR过表达是原发性肝癌患者肝切除术后肝衰竭的影响因素(OR＞1,P<0.05);绘制ROC曲线结果显示,术前NLR水平预测原发性肝癌患者肝切除术后肝衰竭的曲线下面积(AUC)为0.812,＞0.80,预测价值较理想。结论原发性肝癌患者NLR水平普遍较高,可能提示患者术后肝衰竭风险,临床可考虑通过检测原发性肝癌患者肝切除术前NLR水平,来预测患者术后肝衰竭风险,指导早期风险评估与防治。

关键词: 原发性肝癌, 肝切除术, 肝衰竭, 中性粒细胞/淋巴细胞, 相关性

Abstract: Objective To analyze the relationship between preoperative neutrophil/lymphocyte ratio (NLR) and liver failure after hepatectomy in patients with primary hepatic carcinoma, and to guide the future prediction and prevention of liver failure after hepatectomy in patients with primary hepatic carcinoma.Methods A retrospective analysis was conducted. Two hundred and seventy-four patients with primary hepatic carcinoma who underwent hepatectomy treatment and were followed up postoperatively in our hospital from March 2017 to November 2019 were collected as liver cancer group, 67 patients with pathologically confirmed benign liver tumors were collected as control group. The levels of neutrophils (NE), lymphocytes (LY) and NLR of the two groups were detected and compared before operation; the patients of liver cancer group were divided into liver failure group and non-hepatic failure group according to whether liver failure occurred after hepatectomy, comparing the levels of NE, LY and NLR of the two groups before the operation to analyze the influence of the preoperative NLR level on the occurrence of liver failure after hepatectomy, and the receiver operator characteristic (ROC) curve was conducted to analyze the predictive value of preoperative NLR levels on the risk of liver failure after hepatectomy.Results The levels of NE and NLR before operation in the liver cancer group were statistically significant higher than those in the control group, and the LY level was lower than that in the control group (P<0.05). Liver failure occurred in 32 patients of the liver cancer group after hepatectomy, the incidence rate was 11.68%; the levels of NE and NLR before operation of liver failure group were higher than those of the non-hepatic failure group, and the LY level was lower than that of the non-hepatic failure group, the difference was statistically significant (P<0.05). The binary logistic regression analysis showed that NLR overexpression before surgery was an influencing factor for the occurrence of liver failure after hepatectomy in patients with primary hepatic carcinoma (OR>1, P<0.05); ROC curve was conducted and the area under the curve (AUC) of the preoperative NLR level predicting the occurrence of liver failure after hepatectomy was: 0.812 > 0.80, the predictive value was ideal.Conclusion The NLR level of patients with primary hepatic carcinoma is generally high, which may indicate the risk of liver failure after surgery. The preoperative NLR level can be a clinical risk factor to predict the occurrence risk of liver failure in patients with primary hepatic carcinoma after hepatectomy, and guide early risk assessment, prevention and treatment.

Key words: Primary hepatic carcinoma, Hepatectomy, Liver failure, Neutrophils/lymphocytes, Correlation

朱翊, 赵萍, 李杰珍, 冉博. 术前NLR水平与原发性肝癌患者肝切除术后肝衰竭的相关性[J]. 肝脏, 2021, 26(8): 857-860.

ZHU Yi, ZHAO Ping, LI Jie-zhen, RAN Bo. Correlation between preoperative NLR level and liver failure after hepatectomy in patients with primary hepatic carcinoma[J]. Chinese Hepatolgy, 2021, 26(8): 857-860.

参考文献

[1] Ock CY,Nam AR,Lee J,et al.Prognostic implication of antitumor immunity measured by the neutrophil-lymphocyte ratio and serum cytokines and angiogenic factors in gastric cancer.Gastric Cancer,2017,20:254-262.
[2] 李佳庆,王清莹,程忠平.肿瘤相关性中性粒细胞促肿瘤转移机制的研究进展.中国肿瘤临床,2019,46:524-527.
[3] Li K,Zhu Z,Luo J,et al.Impact of chemokine receptor CXCR3 on tumor-infiltrating lymphocyte recruitment associated with favorable prognosis in advanced gastric cancer.Int J Clin Exp Pathol,2015,8:14725-14732.
[4] Tosolini M,Frédéric P,Poupot M,et al.Assessment of tumor-infiltrating TCRVγ9Vδ2 γδ lymphocyte abundance by deconvolution of human cancers microarrays.Oncoimmunology,2017,6:e1284723.
[5] Qin B,Ma N,Tang Q,et al.Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) were Useful Markers in Assessment of Inflammatory Response and Disease Activity in SLE patients.Mod Rheumatol,2016,26:372-376.
[6] 李文,王璐,张军成,等.术前外周血中性粒细胞及血小板与淋巴细胞比值对子宫内膜癌患者预后的影响.医学研究生学报,2018,31:60-64.
[7] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南.中华内科杂志,2006,45:1053-1056.
[8] 麦荣云,叶甲舟,曾洁,等.血清前白蛋白-胆红素评分预测乙肝相关性肝细胞癌肝切除术后肝衰竭的价值.中华肝胆外科杂志,2018,24:737-741.
[9] 张长坤,张龙辉,王东,等.术前肝功能Child－Pugh评分与白蛋白－胆红素评分对肝癌患者肝切除术后肝衰竭和预后的预测价值.中华消化外科杂志,2018,17:474-482.
[10] 廖楚舒,邓中华,乐杨桦,等.Th17相关炎症因子与原发性肝癌关系的研究.实用预防医学,2016,23:554-556.
[11] 于艳龙,刘中华,史赢,等.术前中性粒细胞与淋巴细胞比值和肿瘤相关因素预测肝癌患者微血管浸润.中华肝胆外科杂志,2019,25:120-123.
[12] 李程豪.肿瘤微环境与中性粒细胞相互作用关系的研究进展.中国肿瘤,2018,27:847-850.
[13] Sierzega M,Lenart M,Rutkowska M,et al.Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer.Ann Surg Oncol,2017,24:808-815.
[14] Kavunja HW,Lang S,Sungsuwan S,et al.Delivery of foreign cytotoxic T lymphocyte epitopes to tumor tissues for effective antitumor immunotherapy against pre-established solid tumors in mice.Cancer Immunol Immunother,2017,66:451-460.
[15] Kadagidze ZG,Slavina EG,Chertkova AI.Lymphocyte receptors that regulate the immune-response--the key to the management of antitumor immunity.Vopr Onkol,2015,61:523-529.
[16] Gao Y,Wang WJ,Zhi Q,et al.Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer.Oncotarget,2017,8:88835-88844.
[17] Hu K,Lou L,Ye J,et al.Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis.BMJ Open,2015,5:e006404.
[18] Dirican N,Karakaya YA,Gunes S,et al.Association of intra-tumoral tumour-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio is an independent prognostic factor in non‐small cell lung cancer.Clin Respir J,2017,11:789-796.