降钙素原、中性粒细胞/淋巴细胞比值及二者联合对预测胃癌术后吻合口瘘的价值

The Value of Procalcitonin, Neutrophil to Lymphocyte Ratio and Combination in Prediction of Anastomotic Leakage after Gastric Cancer Surgery

摘要: 目的：探讨降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)及二者联合对预测胃癌术后吻合口瘘的价值。方法：回顾性分析2021.01~2022.12在本院胃肠外科行胃癌外科手术治疗的135例患者临床资料，根据术后是否发生吻合口瘘分为非吻合口瘘组(93例)和吻合口瘘组(42例)，采用倾向性评分匹配法(PSM)减少混杂因素的影响，比较两组患者一般临床资料间的差异。比较匹配后患者术后第1、3、5、7天的PCT、NLR差异，采用受试者工作特征(ROC)曲线评价PCT、NLR及二者联合检测对预测胃癌术后吻合口瘘的价值。结果：吻合口瘘组PCT数值在术后第3、5、7天高于非吻合口瘘组，差异有统计学意义(P < 0.05)；吻合口瘘组NLR数值在术后第5、7天高于非吻合口瘘组，差异有统计学意义(P < 0.05)。ROC曲线分析显示，术后第5天PCT联合NLR的AUC最大，为0.913，约登指数为0.75，灵敏度为87.5%，特异度为87.5%。术后第3天PCT的AUC为0.804，约登指数为0.563，截断值为1.725 ng/ml，P < 0.05，差异有统计学意义。结论：PCT、NLR及二者联合对预测胃癌术后吻合口瘘有价值，其中术后第5天PCT联合NLR预测效果最佳，与此同时，由于早期性，术后第3天当PCT > 1.725 ng/ml时，也应该警惕吻合口瘘的发生。

Abstract: Objective: To investigate the value of procalcitonin (PCT), neutrophil/lymphocyte ratio (NLR) and their combination in prediction of anastomotic leakage in patients with gastric cancer. Methods: the clinical data of 135 patients who underwent gastric cancer surgery in the Hospital of department of gastrointestinal surgery were analyzed retrospectively. According to the occurrence of anastomotic leakage after surgery, the patients were divided into two groups: non-anastomotic leakage group (n = 93) and anastomotic leakage group (n = 42). Propensity score matching (PSM) was used to reduce the influence of confounding factors, The differences of general clinical data between the two groups were compared The PCT and NLR of matched Patients on the 1st, 3rd, 5th and 7th day after surgery were compared, and the Receiver Operating characteristic (ROC) curve analysis was used to evaluate the value of PCT, NLR and their combination in prediction of postoperative anastomotic leakage in gastric cancer. Result: The PCT value of anastomotic leakage group was higher than that of non-anastomotic leakage group on the 3th, 5th and 7th day after operation, and the difference was statistically significant. On the 5th and 7th day after operation, the NLR value of anastomotic leakage group was higher than that of non-anastomotic leakage group, and the difference was statistically significant. ROC curve analysis showed that on the 5th day after operation, the AUC of PCT combined with NLR was the biggest, which was 0.913, the Youden index was 0.75, the sensitivity was 87.5% and the specificity was 87.5%. On the 3rd day after operation, the AUC of PCT was 0.804. The Youden index was 0.563 and the cutoff value was 1.725 ng/ml. Conclusion PCT, NLR and their combination have predictive value in prediction of gastric cancer for post-operation AL, in which the effect of PCT combined with NLR is the best on the 5th day after operation. On the 3rd day after operation, because of the early characteristic, when PCT > 1.725 ng/ml, we should also pay attention to the occurrence of anastomotic leakage.