中性粒细胞/淋巴细胞比值联合CA19-9对肝内胆管癌的诊断价值

doi:10.3877/cma.j.issn.2095-3232.2019.04.018

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (04) : 358 -361. doi: 10.3877/cma.j.issn.2095-3232.2019.04.018

所属专题：文献；

临床研究

中性粒细胞/淋巴细胞比值联合CA19-9对肝内胆管癌的诊断价值

陈亚琼¹, 田琪², 龚娇¹, 杜龙庭¹, 张彤³^,^†(

)

^1. 510630　广州，中山大学附属第三医院检验科
^2. 510630　广州，中山大学附属第三医院产科
^3. 510630　广州，中山大学附属第三医院肝移植科

收稿日期:2019-05-05 出版日期:2019-08-10
通信作者: 张彤
基金资助:
器官移植临床医学研究中心培育项目(2017B020209004)

Diagnostic value of neutrophil/lymphocyte ratio combined with CA19-9 for intrahepatic cholangiocarcinoma

Yaqiong Chen¹, Qi Tian², Jiao Gong¹, Longting Du¹, Tong Zhang³^,^†()

^1. Department of Clinical Laboratory, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
^2. Department of Obstetrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
^3. Department of Liver Transplantation, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

Received:2019-05-05 Published:2019-08-10
Corresponding author: Tong Zhang
About author:
Corresponding author: Zhang Tong, Email: zhjeff72@sina.com

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引用本文：

陈亚琼, 田琪, 龚娇, 杜龙庭, 张彤. 中性粒细胞/淋巴细胞比值联合CA19-9对肝内胆管癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2019, 08(04): 358-361.

Yaqiong Chen, Qi Tian, Jiao Gong, Longting Du, Tong Zhang. Diagnostic value of neutrophil/lymphocyte ratio combined with CA19-9 for intrahepatic cholangiocarcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(04): 358-361.

目的

探讨中性粒细胞/淋巴细胞比值（NLR）联合CA19-9在肝内胆管癌（ICC）中的诊断价值。

方法

本研究对象为2012年1月至2017年10月在中山大学附属第三医院确诊为ICC的70例患者（胆管癌组），同期胆管良性病变患者80例（良性病变组）及健康体检者80例（对照组）。患者均签署知情同意书，符合医学伦理学规定。其中胆管癌组男44例，女26例；平均年龄（54±12）岁。良性病变组男54例，女26例；年龄（55±13）岁。对照组男52例，女28例；年龄（51±10)岁。收集患者初次入院的血常规、CA19-9及CA125，计算NLR和血小板/淋巴细胞比值（PLR）。采用受试者工作特征（ROC）曲线分析各指标单独和联合检测诊断ICC的效能。

结果

NLR、PLR、CA19-9及CA125诊断ICC的ROC曲线下面积分别为0.848、0.780、0.881及0.860，诊断界值分别为2.3、168、19 kU/L、21 kU/L。NLR、PLR、CA19-9及CA125敏感度分别为0.81、0.51、0.74、0.67，特异度为0.86、0.91、0.98、0.90。NLR+PLR、NLR+CA19-9、NLR+CA125、CA19-9+CA125联合检测ROC曲线下面积分别为0.857、0.963、0.927、0.938，敏感度为0.86、0.96、0.93、0.89，特异度为0.81、0.88、0.84、0.88。

结论

单独检测NLR、PLR、CA19-9、CA125对肝内胆管癌有一定的诊断价值，诊断效能较佳，NLR+CA19-9联合检测具有更好的诊断价值。

关键词: 胆管肿瘤, 抗原，肿瘤相关，碳水化合物, 诊断

Objective

To investigate the diagnostic value of neutrophil/lymphocyte ratio (NLR) combined with CA19-9 for intrahepatic cholangiocarcinoma (ICC).

Methods

70 ICC patients (ICC group), 80 patients with benign bile duct lesions (benign lesion group) and 80 healthy subjects (control group) admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to October 2017 were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. In the ICC group, 44 patients were male and 26 female, aged (54±12) years on average. In the benign lesion group, 54 cases were male and 26 female, aged (55±13) years on average. In the control group, 52 patients were male and 28 female, aged (51±10) years on average. Upon the initial admission, blood routine test, CA19-9 and CA125 of the patients were collected and NLR and platelet/lymphocyte ratio (PLR) were calculated. The diagnostic efficiency of single and combined parameters for ICC was evaluated by the ROC curve.

Results

The area under ROC curve of NLR, PLR, CA19-9 and CA125 in diagnosis of ICC was 0.848, 0.780, 0.881 and 0.860, respectively. The diagnostic threshold values were 2.3, 168, 19 kU/L and 21 kU/L, respectively. The sensitivity of NLR, PLR, CA19-9 and CA125 was 0.81, 0.51, 0.74 and 0.67, respectively. The specificity of NLR, PLR, CA19-9 and CA125 was 0.86, 0.91, 0.98 and 0.90, respectively. The area under ROC curve of NLR+PLR, NLR+CA19-9, NLR+CA125 and CA19-9+CA125 was 0.857, 0.963, 0.927 and 0.938, respectively. The sensitivity was 0.86, 0.96, 0.93 and 0.89, and the specificity was 0.81, 0.88, 0.84 and 0.88, respectively.

Conclusions

Single detection of NLR, PLR, CA19-9 and CA125 is of certain value in the diagnosis of ICC with relatively high diagnostic efficiency. However, the combined detection of NLR and CA19-9 yields better diagnostic value compared with single parameter.

Key words: Bile duct neoplasms, Antigens, tumor-associated, carbohydrate, Diagnosis

表1 胆管癌组、良性病变组和对照组NLR、PLR、CA19-9、CA125比较[M（Q_R）]

组别		例数	NLR	PLR	CA19-9(kU/L)	CA125(kU/L)
胆管癌组		70	4.4（2.1～15.0）	162（64～321）	619.4（333.2～1 077.0）	76.7（41.7～250.8）
良性病变组		80	1.9（1.0～9.1）	125（66～212）	4.8（2.0～55.3）	6.8（2.0～57.3）
对照组		80	1.8（0.8～6.2）	114（43～241)	4.6（2.0～37.3）	8.3（2.0～36.7）
?	Z₁值	?	-8.823	-3.739	-10.242	-10.428
?	Z₂值	?	-9.777	-5.220	-9.239	-9.423
?	Z₃值	?	-1.747	-1.707	-0.031	-1.778
?	P₁值	?	<0.05	<0.05	<0.05	<0.05
?	P₂值	?	<0.05	<0.05	<0.05	<0.05
?	P₃值	?	>0.05	>0.05	>0.05	>0.05

表1 胆管癌组、良性病变组和对照组NLR、PLR、CA19-9、CA125比较[M（Q_R）]

组别		例数	NLR	PLR	CA19-9(kU/L)	CA125(kU/L)
胆管癌组		70	4.4（2.1～15.0）	162（64～321）	619.4（333.2～1 077.0）	76.7（41.7～250.8）
良性病变组		80	1.9（1.0～9.1）	125（66～212）	4.8（2.0～55.3）	6.8（2.0～57.3）
对照组		80	1.8（0.8～6.2）	114（43～241)	4.6（2.0～37.3）	8.3（2.0～36.7）
?	Z₁值	?	-8.823	-3.739	-10.242	-10.428
?	Z₂值	?	-9.777	-5.220	-9.239	-9.423
?	Z₃值	?	-1.747	-1.707	-0.031	-1.778
?	P₁值	?	<0.05	<0.05	<0.05	<0.05
?	P₂值	?	<0.05	<0.05	<0.05	<0.05
?	P₃值	?	>0.05	>0.05	>0.05	>0.05

表2 NLR、PLR、CA19-9、CA125对ICC的诊断效能评价

指标	ROC曲线下面积	敏感度	特异度	约登指数
NLR	0.848	0.81	0.86	0.68
PLR	0.780	0.51	0.91	0.43
CA19-9	0.881	0.74	0.98	0.73
CA125	0.86	0.67	0.90	0.67

表2 NLR、PLR、CA19-9、CA125对ICC的诊断效能评价

指标	ROC曲线下面积	敏感度	特异度	约登指数
NLR	0.848	0.81	0.86	0.68
PLR	0.780	0.51	0.91	0.43
CA19-9	0.881	0.74	0.98	0.73
CA125	0.86	0.67	0.90	0.67

表3 NLR、PLR、CA19-9、CA125联合检测诊断ICC的效能评价

指标组合	ROC曲线下面积	敏感度	特异度	约登指数
NLR+PLR	0.857	0.86	0.81	0.67
NLR+CA19-9	0.963	0.96	0.88	0.83
NLR+CA125	0.927	0.93	0.84	0.77
CA19-9+CA125	0.938	0.89	0.88	0.76

表3 NLR、PLR、CA19-9、CA125联合检测诊断ICC的效能评价

指标组合	ROC曲线下面积	敏感度	特异度	约登指数
NLR+PLR	0.857	0.86	0.81	0.67
NLR+CA19-9	0.963	0.96	0.88	0.83
NLR+CA125	0.927	0.93	0.84	0.77
CA19-9+CA125	0.938	0.89	0.88	0.76

图1 NLR与CA19-9联合检测诊断ICC的ROC曲线

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