佳文分享丨血小板与淋巴细胞比值对卵巢癌患者国际妇产科联盟临床分期的预测价值

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作者：唐英 李均 胡辉权 徐凡 陈明星

来源：中华妇幼临床医学杂志（电子版）, 2019,15(3) : 268-274. DOI: 10.3877/cma.j.issn.1673-5250.2019.03.006

摘要

目的

探讨血小板与淋巴细胞比值(PLR)对卵巢癌患者国际妇产科联盟(FIGO)临床分期的预测价值。

方法

选择2005年1月至2017年1月，于南充市中心医院就诊的225例初治卵巢癌患者为研究对象。采取回顾性分析方法，根据FIGO分期，将其分为早期卵巢癌组(n＝85，FIGO分期为Ⅰ～Ⅱ期)和晚期卵巢癌组(n＝140，FIGO分期为Ⅲ～Ⅳ期)。采用Wilcoxon秩和检验，对2组患者的年龄、人体质量指数(BMI)、白细胞计数、血红蛋白(Hb)水平、PLR和中性粒细胞与淋巴细胞比值(NLR)进行统计学分析。采用χ2检验，对2组患者的组织病理学类型、合并恶性腹水患者所占比例、血清CA125水平>35 U/mL所占比例等进行统计学分析。绘制受试者工作特征(ROC)曲线，对PLR预测卵巢癌患者FIGO分期进行分析，并计算ROC曲线下面积(ROC-AUC)。采用多因素非条件logistic回归分析，判断PLR预测卵巢癌患者FIGO临床分期的准确性。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①2组患者的年龄、BMI、Hb水平和白细胞计数比较，差异均无统计学意义(P>0.05)；而其组织病理学类型、是否合并恶性腹水、血清CA125水平>35 U/mL、PLR和NLR比较，则差异均有统计学意义(χ2＝16.897、76.187、11.817、－5.252、－3.790, P均<0.05)。②组织病理学类型(OR＝2.460，95%CI＝1.246～4.856，P＝0.009)，是否合并恶性腹水(OR＝6.649，95%CI＝3.437～12.862，P<0.001)和PLR(OR＝1.005，95%CI＝1.001～1.009，P＝0.027)，均为预测卵巢癌患者FIGO分期的独立危险因素。③PLR对预测卵巢癌患者FIGO分期的ROC-AUC为0.709(95%CI：0.645～0.767，P<0.001)。根据约登指数最大原则，PLR预测卵巢癌患者FIGO临床分期的最佳临界值为157.14。其中，本研究225例初治卵巢癌患者中，PLR>157.14者为134例，PLR≤157.14者为91例。此时，PLR对预测卵巢癌患者FIGO分期的敏感度为72.9%，特异度为63.5%。

结论

PLR值可预测卵巢癌FIGO分期。当PLR>157.14时，卵巢癌患者FIGO临床分期为晚期的可能性较大。

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