炎症指标对孤立性肺结节良恶性鉴别的价值分析

Analysis of the Value of Inflammatory Indices in the Differentiation of Benign and Malignant Isolated Pulmonary Nodules

摘要: 目的：比较良恶性孤立性肺结节(SPN)患者术前中性粒细胞与淋巴细胞比值(NLR)、全身炎症综合指数(AISI)、血小板与淋巴细胞比值(PLR)、血小板与白细胞比值(PWR)、单核细胞与淋巴细胞比值(MLR)、衍生中性粒细胞–淋巴细胞比率(dNLR)、系统免疫炎症指数(SII)、系统炎症反应指数(SIRI)和淋巴细胞与白细胞比率(LWR)的差异，并探讨其在肺结节良恶性鉴别诊断中的应用价值。方法：本研究将本院心胸外科手术的和经呼吸内科病理诊断的165例孤立性肺结节病人作为研究对象，将其纳入良性病变组(43例)与肺腺癌组(122例)；计算其术前NLR、PLR、MLR、SII、SIRI、dNLR、PWR、AISI和LWR数据，分别比较两组之间的数据有无统计学差异，并分析各指标的诊断价值。结果：肺腺癌组NLR、PLR、SII、SIRI、dNLR和AISI均高于良性病变组(P值分别为0.009、0.042、0.001、0.026、0.003、0.002)。肺腺癌组的LWR低于良性病变组(P = 0.015)。MLR、PWR在肺腺癌组和良性病变组中的差异无统计学意义(P值分别为0.299、0.770)。结论：研究提示全身炎症指标在肺腺癌早期就开始发生变化，上述炎症指标检测对SPN良恶性的早期鉴别具有一定参考价值，其中SII是鉴别良恶性肺结节较为可观的预测指标，上述指标联合检测的诊断效能与SII差别不明显。

Abstract: Objective: To compare the preoperative neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory syndrome index (AISI), platelet-to-lymphocyte ratio (PLR), platelet-to-leukocyte ratio (PWR), monocyte-to-lymphocyte ratio (MLR), derived neutrophil-to-lymphocyte ratio (dNLR), systemic immunoinflammatory index (SII), Systemic Inflammatory Response Index (SIRI), and Lymphocyte-to-White Blood Cell Ratio (LWR), and to explore their value in differential diagnosis. Methods: In this study, 165 patients with isolated pulmonary nodules operated on by our cardiothoracic surgery and diagnosed pathologically by respiratory medicine were included in the benign lesion group (43 patients) and lung adenocarcinoma group (122 patients). We calculated the data of their preoperative NLR, PLR, MLR, SII, SIRI, dNLR, PWR, AISI, and LWR, respectively, and compared the data between the two groups for any statistical differences, and analyse the diagnostic value of each index. Results: NLR, PLR, SII, SIRI, dNLR and AISI were higher in the lung adenocarcinoma group than in the benign lesion group (P values of 0.009, 0.042, 0.001, 0.026, 0.003, 0.002, respectively). LWR was lower in the lung adenocarcinoma group than in the benign lesion group (P = 0.015). The difference between MLR and PWR in the lung adenocarcinoma group and the benign lesion group was not statistically significant (P-values of 0.299 and 0.770, respectively). Conclusion: The study suggests that systemic inflammatory indexes begin to change at the early stage of lung adenocarcinoma, and the above inflammatory indexes have certain reference value for the early identification of benign and malignant SPN, of which SII is a more predictive index for identifying benign and malignant nodules, and the diagnostic efficacy of the combination of the above indexes does not differ significantly from that of SII.