中性粒细胞和淋巴细胞比值与头颈恶性肿瘤放疗过程中口腔黏膜炎的相关性

Correlation between Neutrophil to Lymphocyte Ratio and Oral Mucositis during Radiotherapy for Head and Neck Cancer

摘要: 目的：探讨中性粒细胞与淋巴细胞比值(NLR)对头颈部恶性肿瘤(HNC)放疗患者口腔粘膜炎(OM)的相关性。方法：选取2020年6月至2021年1月在青岛大学附属烟台毓璜顶医院行放射治疗的31例HNC患者为研究对象，依据受试者工作特征曲线(ROC)中NLR最佳截断值分为低NLR组及高NLR组。分别根据WHO标准和OMAS量表对患者OM进行评估，将WHO分级为3级和4级的定义为严重OM。分析放疗前NLR水平与HNC患者放疗过程中OM之间的联系。结果：依据ROC曲线，放疗前NLR的最佳截取值为2.95。根据WHO标准和OMAS标准，高NLR组患者出现严重OM的比例高于低NLR组，且高NLR组的OMAS评分高于低NLR组(均P < 0.05)。在单因素分析中，NLR水平、临床分期、N分期与患者发生严重OM显著相关，logistic多因素回归分析表明影响患者发生严重OM的独立危险因素为NLR水平、N分期；NLR对HNC放疗患者严重OM的发生具有一定的诊断价值(均P < 0.05)。结论：NLR与HNC患者放疗过程中OM严重程度相关，且对严重OM的发生具有一定的预测价值。

Abstract: Objective: To investigate the correlation between neutrophil to lymphocyte ratio (NLR) and oral mucositis (OM) in patients receiving radiotherapy for head and neck cancer (HNC). Methods: A total of 31 HNC patients undergoing radiotherapy in Yantai Yuhuangding Hospital Affiliated to Qingdao University from June 2020 to January 2021 were enrolled. According to the optimal cut-off value of NLR in receiver operating characteristic curve (ROC), they were divided into low NLR group and high NLR group. Patients were evaluated for OM according to WHO criteria and OMAS scale, respec-tively, and those with WHO grading of grade 3 and 4 were defined as severe OM to analyze the asso-ciation between pre-radiotherapy NLR levels and OM during radiotherapy in HNC patients. Results: The ROC indicated that the optimal intercept value of NLR before radiotherapy was 2.95. According to WHO criteria and OMAS criteria, the proportion of patients with severe OM was higher in the high NLR group than in the low NLR group, and the OMAS score was higher in the high NLR group than in the low NLR group (all P < 0.05). In the univariate analysis, NLR level, clinical stage and N stage were significantly associated with the occurrence of severe OM in patients, and multivariate logistic regression analysis showed that the independent risk factors affecting the occurrence of severe OM in patients were NLR level and N stage; NLR had a diagnostic value for the occurrence of severe OM in HNC radiotherapy patients (all P < 0.05).