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

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。

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

ObjectiveTo 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. Methods183 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. ResultsBefore 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) . ConclusionThe 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.