中性粒细胞与淋巴细胞比值在非小细胞肺癌合并阻塞性睡眠呼吸暂停低通气综合征患者中的临床意义

柳芳美; 凡国华; 徐金静; 王庆; 杨俊俊; 闵凌峰; 张梦; 吴书清

doi:10.7619/jcmp.20220929

中性粒细胞与淋巴细胞比值在非小细胞肺癌合并阻塞性睡眠呼吸暂停低通气综合征患者中的临床意义

1.
江苏省苏北人民医院心血管内科, 江苏扬州, 225001
2.
江苏省苏北人民医院呼吸与危重症医学科, 江苏扬州, 225001

基金项目:

国家自然科学基金资助项目 81900085

国家自然科学基金资助项目 81800049

详细信息

通讯作者:
吴书清, E-mail: shuqing_1987@126.com

中图分类号: R734.2;R446.11
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出版历程
- 收稿日期: 2022-03-23
- 网络出版日期: 2022-08-22

Clinical significance of neutrophil to lymphocyte ratio in patients with non-small cell lung cancer complicated with obstructive sleep apnea hypopnea syndrome

1.
Department of Cardiology, Subei People's Hospital in Jiangsu Province, Yangzhou, Jiangsu, 225001
2.
Department of Respiratory and Critical Care Medicine, Subei People's Hospital in Jiangsu Province, Yangzhou, Jiangsu, 225001

摘要

摘要:
目的
探讨中性粒细胞与淋巴细胞比值(NLR)在非小细胞肺癌合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中的表达及其与睡眠呼吸暂停相关指标的关系。
方法
选取31例首次诊断的非小细胞肺癌合并OSAHS患者纳入合并组, 另选取同期就诊的31例单纯非小细胞肺癌患者、31例健康体检者分别纳入单纯组、对照组，比较各组NLR、血小板与淋巴细胞比值(PLR)差异，分析非小细胞肺癌合并OSAHS组NLR、PLR水平与睡眠呼吸暂停相关指标的关系，并分析OSAHS对不同肺癌分期组患者NLR、PLR水平的影响。
结果
合并组、单纯组NLR水平分别为(4.95±3.36)、(3.61±1.48), 均高于对照组的(1.87±0.48), 差异有统计学意义(P＜0.01);合并组NLR水平高于单纯组，差异有统计学意义(P＜0.05)。合并组、单纯组PLR水平均高于对照组，差异有统计学意义(P＜0.05或P＜0.01);合并组PLR水平与单纯组比较，差异无统计学意义(P＞0.05)。偏相关分析结果显示，校正年龄、体质量指数(BMI)后, NLR与非小细胞肺癌合并OSAHS患者睡眠呼吸暂停低通气指数(AHI)呈正相关(r=0.567, P=0.002), 与最低动脉血氧饱和度(SaO₂)呈负相关(r=-0.340, P=0.048)。Ⅰ~Ⅲ期肺癌组中，合并OSAHS患者的NLR、PLR水平高于无OSAHS患者，差异有统计学意义(P＜0.05);Ⅳ期肺癌组中，合并OSAHS患者的NLR、PLR水平亦高于无OSAHS患者，但差异无统计学意义(P＞0.05)。
结论
非小细胞肺癌合并OSAHS患者的NLR水平相较单纯非小细胞肺癌患者和健康者显著升高，且其NLR水平与AHI、最低SaO₂具有相关性。
- 非小细胞肺癌 /
- 中性粒细胞与淋巴细胞比值 /
- 阻塞性睡眠呼吸暂停低通气综合征 /
- 睡眠呼吸暂停低通气指数 /
- 最低动脉血氧饱和度
Abstract:
Objective
To investigate the expression of neutrophil to lymphocyte ratio (NLR) and its relationship with obstructive sleep apnea hypoventilation syndrome (OSAHS) in non-small cell lung cancer patients with OSAHS.
Methods
Thirty-one initially diagnosed as non-small-cell lung cancer patients combined with OSAHS were selected as combination group, and 31 patients with simple non-small-cell lung cancer and 31 healthy people were selected as simple group and control group, respectively. The differences in NLR, platelet to lymphocyte ratio (PLR) among groups were compared. Correlations of NLR and PLR with indicators related to sleep apnea in the combined group, and effects of OSAHS on NLR and PLR levels of patients with different lung cancer stages were analyzed.
Results
NLR levels in the combined group and the simple group were (4.95±3.36) and (3.61±1.48), respectively, which were higher than (1.87±0.48) in the control group (P < 0.01). The level of NLR in the combined group was higher than that in the simple group (P < 0.05). The PLR levels of the combined group and the simple group were higher than those of the control group (P < 0.05 or P < 0.01). There was no significant difference in PLR level between the combined group and the simple group (P > 0.05). A partial correlation analysis showed that after adjusting for age and BMI, NLR had a positive correlation with sleep apnea hypopnea index (AHI) (r=0.567, P=0.002)and a negative correlation with minimum arterial oxygen saturation (SaO₂) in non-small cell lung cancer combined with OSAHS patients(r=-0.340, P=0.048). The levels of NLR and PLR in patients complicated with OSAHS in stage Ⅰ to Ⅲ lung cancer group were higher than those in patients without OSAHS (P < 0.05). The levels of NLR and PLR in patients complicated with OSAHS were also higher than those in patients without OSAHS in stage Ⅳ lung cancer group, but the differences were not statistically significant (P > 0.05).
Conclusion
NLR levels are significantly increased in patients with non-small cell lung cancer combined with OSAHS compared with the controls and patients with simple non-small cell lung cancer, and there are correlations of NLR level with AHI and the minimum SaO₂.
- non-small cell lung cancer /
- neutrophil to lymphocyte ratio /
- obstructive sleep apnea hypoventilation syndrome /
- sleep apnea hypopnea index /
- minimum arterial oxygen saturation

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表 1 3组一般资料和血常规指标水平比较(x±s)[n(%)]

指标	对照组(n=31)	单纯组(n=31)	合并组(n=31)
年龄/岁	59.87±11.50	60.19±10.95	59.58±11.03
性别男	22(70.97)	22(70.97)	22(70.97)
女	9(29.03)	9(29.03)	9(29.03)
体质量指数/(kg/m²)	23.54±2.03	24.23±2.03	27.63±3.32^**##
中性粒细胞/(×10⁹/L)	3.74±0.98	5.29±1.89^*	5.61±1.64^**
淋巴细胞/(×10⁹/L)	2.01±0.65	1.64±0.72	1.31±0.51^*#
中性粒细胞与淋巴细胞比值	1.87±0.48	3.61±1.48^**	4.95±3.36^**#
血小板/(×10⁹/L)	228.14±46.66	231.81±48.59	231.94±61.89
血小板与淋巴细胞比值	118.43±35.44	159.84±54.62^*	169.57±62.33^**
与对照组比较, * P＜0.05, * * P＜0.01; 与单纯组比较, #P＜0.05, ##P＜0.01。

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表 2 NLR、PLR水平与睡眠呼吸暂停相关指标的相关性分析

指标	NLR				PLR
指标	相关系数	P	偏相关系数	P	相关系数	P	偏相关系数	P
AHI	0.564	0.001	0.567	0.002	0.119	0.523	0.321	0.096
最低SaO₂	-0.374	0.038	-0.340	0.048	-0.241	0.191	-0.222	0.128
TS90%	0.314	0.085	0.277	0.077	0.124	0.505	0.256	0.189
AHI: 睡眠呼吸暂停低通气指数; SaO₂: 动脉血氧饱和度; TS90%: 血氧饱和度低于90%的时间占总监测时间的百分比; NLR: 中性粒细胞与淋巴细胞比值; PLR: 血小板与淋巴细胞比值。

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表 3 OSAHS对不同肺癌分期患者NLR、PLR水平的影响(x±s)

指标	Ⅰ~Ⅲ期肺癌组(n=30)			Ⅳ期肺癌组(n=32)
指标	无OSAHS(n=15)	合并OSAHS(n=15)	P	无OSAHS(n=16)	合并OSAHS(n=16)	P
NLR	2.88±1.00	4.12±0.91	0.002	4.30±1.55	5.64±4.40	0.257
PLR	136.32±51.39	178.34±49.47	0.034	181.89±49.30	201.16±77.47	0.404
NLR: 中性粒细胞与淋巴细胞比值; PLR: 血小板与淋巴细胞比值: OSAHS: 阻塞性睡眠呼吸暂停低通气综合征。

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