摘要： 目的 探讨血小板(PLT)及相关参数,如血小板与淋巴细胞比值(PLR)、血小板与中性粒细胞比值(PNR)、血小板与单核细胞比值(PMR)在上皮性卵巢肿瘤患者术前外周血中的临床意义。方法 收集2015年6月—2018年6月于哈尔滨医科大学附属第一医院初次行卵巢肿瘤手术的272例患者的临床资料,依据病理类型分为良性组和恶性组。其中,良性组175例,均为浆液性囊腺瘤和黏液性囊腺瘤。恶性组97例,依据二元理论分为I型组和II型组,I型组(低级别卵巢浆液性癌、低级别卵巢子宫内膜样癌、卵巢透明细胞癌、黏液性癌)34例,II型组(高级别卵巢浆液性癌、高级别卵巢子宫内膜样癌、卵巢未分化癌、癌肉瘤)63例;依据病理分期分为I-II期组和III-IV期组,I-II期组52例,III-IV期组45例。收集患者入院后,在未接受任何药物或手术治疗之前抽取空腹血常规,然后整理血常规结果中的中性粒细胞、淋巴细胞、单核细胞、血小板、血小板比积及血小板平均体积、血小板分布宽度,并计算PLR 、PNR、PMR数值。上述各指标均采用(±s)表示,采用两独立样本t检验分析各指标在良性组和恶性组,I型组和II型组及I-II期组和III-IV期组之间的差异,绘制ROC曲线评价PLT、PLR对恶性组病理分期和PNR、PMR对恶性组病理分型的预测效果。结果 卵巢良恶性肿瘤比较中,恶性组中性粒细胞、单核细胞、血小板升高,淋巴细胞降低,PLR升高(P均<0.05);PNR和PMR降低,但差异无统计学意义。在卵巢癌病理分期中,PLT及PLR在III-IV期中较在I-II期中升高,差异有统计学意义;PLR对卵巢癌分期有一定预测效果 (AUC=0.62,P=0.03),最佳临界点为192.73;而PLT对恶性组分期预测效果无统计学意义。在卵巢癌病理分型中,PNR、PMR在I型卵巢癌中比在II型卵巢癌中降低,差异具有统计学意义;PNR、PMR对卵巢癌I型及II型的预测效果均无统计学意义,但PNR曲线下面积(AUC)为0.58,临界点取72.45时,特异性为73.53%。结论 卵巢癌患者术前外周血PLT、PLR 与卵巢癌病理分期有关,PNR、PMR与卵巢癌病理类型I型和II型之间可能存在着密切的关系,这对于卵巢癌的病情分析及治疗有所帮助。
关键词： 血小板(PLT), 血小板与淋巴细胞比值(PLR), 血小板与中性粒细胞比值(PNR), 血小板与单核细胞比值(PMR), 卵巢肿瘤
Abstract: Objective To investigate the clinical significance of platelets and their related parameters such as platelet to lymphocyte ratio (PLR), platelet to neutrophil ratio (PNR), and platelet to mononuclear ratio (PMR) in peripheral blood of patients with epithelial ovarian tumor before operation. Methods 272 patients who underwent the first operation of ovarian tumor surgery in the First Affiliated Hospital of Harbin Medical University from June 2015 to June 2018 were collected and divided into the benign group and the malignant group according to the pathological type of the tumor. Among them, the benign group included 175 cases, all of which were serous and mucinous cystadenomas, and the malignant group included 97 cases. According to the binary theory, the malignant group was divided into type I and type II group, with 34 cases in type I group (including low-grade ovarian serous carcinoma, low-grade ovarian endometrioid carcinoma, clear cell carcinoma of ovary and mucinous carcinoma) and 63 cases in type II group(including high-grade ovarian serous carcinoma, high-grade ovarian endometrioid carcinoma, undifferentiated ovarian carcinoma, and carcinosarcoma). According to the pathological stages, the malignant group was divided into stage I-II group (52 cases) and stage III-IV group (45 cases). The results of fasting peripheral blood routine results were collected after admission before any drug or surgical treatment was given, and neutrophils, lymphocytes, monocytes, platelets, plateletcrit, mean platelet volume and platelet distribution width were collected from the peripheral blood routine results, and PLR, PNR and PMR were calculated. The above indexes were expressed as mean ± standard deviation, and the t-test of two independent samples was used to analyze the difference between the benign group and the malignant group, the type I group and the type II group, and the stage I-II group and the stage III-IV group. The ROC curve was drawn to evaluate the prediction effect of PLT and PLR on the pathological stage of the malignant group and PNR and PMR on the pathological type of the malignant group. Results Compared with benign and malignant group, neutrophils, monocytes and platelets in malignant group increased, lymphocyte decreased; PLR increased (P<0.01); PNR and PMR decreased while there was no statistical significance. In the pathological stage of malignant group, PLT and PLR were significantly higher in stage III-IV group than in stage I-II group(P<0.05); PLR had a certain predictive effect on malignant stage (AUC=0.62, P=0.03), and the critical point was 192.73; PLT had no statistical significance on the prediction of malignant stage. In the pathological type of malignant group, PNR and PMR were lower in type I group than in type II group, the difference was statistically significant (p<0.05); PNR and PMR had no statistical significance on predicting type I and II group, but the area under curve (AUC) of PNR was 0.58, and the specificity was 73.53% when the critical point was 72.45. Conclusion PLT and PLR in preoperative peripheral blood of patients with ovarian cancer are associated with pathological stage of ovarian cancer. PNR and PMR may be closely related to the pathological types I and II, which may be helpful for the analysis and treatment of ovarian cancer.
Key words: platelets (PLT), platelet to lymphocyte ratio (PLR), platelet to neutrophil ratio (PNR), platelet to monocyte ratio (PMR), ovarian tumor