术前外周血中性粒细胞/淋巴细胞比值在乳腺癌诊断中的作用

doi:10.3969/j.issn.1673-8640.2018.03.005

摘要/Abstract

摘要： 目的探讨术前外周血中性粒细胞/淋巴细胞比值（NLR）在乳腺癌诊断中的最佳临界值及其在临床诊断中的作用。方法选取131例行手术治疗的乳腺癌患者（乳腺癌组）和120例乳腺良性病变患者（乳腺良性疾病组）,并以95名女性体检健康者作为正常对照组。采用SYSMEX XT-800i全自动血液分析仪计数中性粒细胞（NE）和淋巴细胞（LY）,计算NLR;采用电化学发光法检测外周血糖类抗原15-3（CA15-3）、糖类抗原125（CA125）、癌胚抗原（CEA）水平。根据受试者工作特征（ROC）曲线确定最佳临界值。结果乳腺癌组术前NLR、NE、LY、CA15-3明显高于正常对照组和乳腺良性疾病组（P<0.05）。NLR的曲线下面积（AUC）为0.935,最佳临界值为1.995,敏感性为85.2%,特异性为87.1%。以NLR为检测基础,联合CA15-3诊断乳腺癌的敏感性为98.0%,特异性为92.6%。结论NLR诊断乳腺癌的最佳临界值为1.995,联合CA15-3能增加乳腺癌诊断的敏感性和特异性,对乳腺癌的诊断、病情评估具有指导意义。

关键词: 中性粒细胞/淋巴细胞比值, 糖类抗原15-3, 乳腺癌

Abstract:

Objective To investigate the role and optimal cut-off value of preoperative peripheral blood neutrophil-to-lymphocyte ratio（NLR） in the diagnosis of breast cancer. Methods A total of 131 breast cancer patients undergoing surgery and 120 patients with benign breast disease were enrolled. Totally,95 healthy females were enrolled as healthy control group. Neutrophil（NE）and lymphocyte（LY）counts were determined by SYSMEX XT-800i automatic hematology analyzer,and NLR was calculated. The levels of carbohydrate antigen 15-3（CA15-3）,carbohydrate antigen 125（CA125）and carcinoembryonic antigen（CEA）in peripheral blood were determined by electrochemiluminescence. According to receiver operating characteristic（ROC）curve,the optimal cut-off value was determined. Results In breast cancer group,NLR,NE,LY and CA15-3 were higher than those in healthy control and benign breast disease groups（P<0.05）. The area under curve（AUC） of NLR was 0.935,the optimal cut-off value was 1.995,the sensitivity was 85.2%,and the specificity was 87.1%. Based on NLR determination,the sensitivity and specificity of the combined determination with CA15-3 were 98.0% and 92.6%,respectively could improve the sensitivity. Conclusions The optimal cut-off value of NLR is 1.995,and the sensitivity and specificity can be improved through the combined determination with CA15-3 in the diagnosis of breast cancer,which can guide the diagnosis and disease severity assessment of breast cancer.

Key words: Neutrophil-to-lymphocyte ratio, Carbohydrate antigen 15-3, Breast cancer

中图分类号:

R446.1

赵卫卫, 肖林林, 刘秀芬, 彭攸, 黄丁丁, 王玉平, 冯景. 术前外周血中性粒细胞/淋巴细胞比值在乳腺癌诊断中的作用[J]. 检验医学, 2018, 33(3): 209-212.

ZHAO Weiwei, XIAO Linlin, LIU Xiufen, PENG You, HUANG dingding, WANG Yuping, FENG Jing. Preoperative peripheral blood neutrophil-to-lymphocyte ratio in the diagnosis of breast cancer[J]. Laboratory Medicine, 2018, 33(3): 209-212.

图/表 4

参考文献 14

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项目	例数	构成比（%）	项目	例数	构成比（%）
年龄（岁）			孕激素受体表达
≤49	54	41.22	阴性	72	54.96
>49	77	58.77	阳性	41	46.04
组织类型			人表皮生长因子
浸润性导管癌	73	55.73	受体2表达	90	68.70
浸润性小叶癌	20	15.27	阴性	41	30.53
髓样癌	15	11.45	阳性
黏液癌	13	9.92	CA15-3	120	91.60
其他	10	7.63	≤25 U/mL	11	8.40
肿瘤分级			>25 U/mL
Ⅰ	12	9.16	CA125	121	92.36
Ⅱ	53	40.45	≤35 U/mL	10	7.64
Ⅲ	66	50.38	>35 U/mL
淋巴结转移			CEA	126	96.18
无转移	113	86.26	≤4.7 ng/mL	5	3.82
有转移	18	13.74	>4.7 ng/mL
雌激素受体表达
阴性	70	53.44
阳性	51	38.91

项目	例数	构成比（%）	项目	例数	构成比（%）
年龄（岁）			孕激素受体表达
≤49	54	41.22	阴性	72	54.96
>49	77	58.77	阳性	41	46.04
组织类型			人表皮生长因子
浸润性导管癌	73	55.73	受体2表达	90	68.70
浸润性小叶癌	20	15.27	阴性	41	30.53
髓样癌	15	11.45	阳性
黏液癌	13	9.92	CA15-3	120	91.60
其他	10	7.63	≤25 U/mL	11	8.40
肿瘤分级			>25 U/mL
Ⅰ	12	9.16	CA125	121	92.36
Ⅱ	53	40.45	≤35 U/mL	10	7.64
Ⅲ	66	50.38	>35 U/mL
淋巴结转移			CEA	126	96.18
无转移	113	86.26	≤4.7 ng/mL	5	3.82
有转移	18	13.74	>4.7 ng/mL
雌激素受体表达
阴性	70	53.44
阳性	51	38.91

组别	例数	NLR	WBC计数（×10⁹/L）	NE （×10⁹/L）	LY （×10⁹/L）	CA15-3 （U/mL）	CA125 （U/mL）	CEA （ng/mL）
正常对照组	95	1.54±0.33	5.52±1.20	3.04±0.82	2.01±0.49	10.13±4.68	13.28±6.43	1.86±1.16
乳腺良性疾病组	120	1.47±1.12	5.68±1.78	3.08±1.25	2.14±2.01	10.22±3.92	14.21±1.27	1.95±2.35
乳腺癌组	131	2.77±2.19^*#	6.15±2.19	3.87±1.92^*#	1.61±0.58^*#	15.60±10.05^*#	15.64±6.48	2.14±1.40

组别	例数	NLR	WBC计数（×10⁹/L）	NE （×10⁹/L）	LY （×10⁹/L）	CA15-3 （U/mL）	CA125 （U/mL）	CEA （ng/mL）
正常对照组	95	1.54±0.33	5.52±1.20	3.04±0.82	2.01±0.49	10.13±4.68	13.28±6.43	1.86±1.16
乳腺良性疾病组	120	1.47±1.12	5.68±1.78	3.08±1.25	2.14±2.01	10.22±3.92	14.21±1.27	1.95±2.35
乳腺癌组	131	2.77±2.19^*#	6.15±2.19	3.87±1.92^*#	1.61±0.58^*#	15.60±10.05^*#	15.64±6.48	2.14±1.40

指标	AUC	95%可信区间	敏感性（%）	特异性（%）
NLR	0.935	0.884~0.978	85.2	87.1
CA15-3	0.918	0.868~0.969	86.6	42.8
NLR+CA15-3			98.0	92.6