监测术前NLR、PLR 及SII 水平对全身麻醉下结直肠癌根治术后并发肠梗阻的预测价值

doi:10.3877/cma.j.issn.2095-2015.2025.03.005

目的

探讨监测术前中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）及全身免疫炎症指数（SII）水平对全身麻醉下结直肠癌根治术后并发肠梗阻的预测价值。

方法

选取2023 年1 月至2025 年1 月在宝鸡市中心医院行全身麻醉下结直肠癌根治术治疗的200 例患者为研究对象，依据术后是否发生肠梗阻分为术后肠梗阻（POI）组（n=30）和非POI 组（n=170）。收集两组患者的年龄、性别、体重指数、合并症（高血压、糖尿病、冠心病）、肿瘤部位、肿瘤TNM分期、病理类型、分化程度、肿瘤大小、手术时间、术前NLR、PLR 及SII 水平，采用Logistic 回归分析全麻下结直肠癌根治术后并发肠梗阻的影响因素，采用受试者工作特征（ROC）曲线分析NLR、PLR 及SII 水平对术后肠梗阻的预测价值。

结果

两组年龄、性别、体重指数、合并症、肿瘤部位、病理类型、分化程度、肿瘤大小、手术时间比较无差异（P＞0.05）；POI 组患者肿瘤TNM分期Ⅲ期的比例高于非POI 组，术前NLR、PLR 及SII 水平高于非POI 组（P＜0.05）；经Logistic回归分析显示，肿瘤TNM 分期Ⅲ期，术前NLR、PLR 及SII 水平均是影响全麻下结直肠癌根治术后并发肠梗阻的危险因素（P＜0.05）；ROC 曲线分析表明，术前NLR、PLR 及SII 预测全麻下结直肠癌根治术后并发肠梗阻的AUC 分别为0.756（95% CI 0.652～0.860）、0.836（95% CI 0.739～0.932）、0.752（95% CI 0.650～0.853），敏感度分别为56.7%、76.7%、46.7%，特异性分别为90.0%、87.1%、97.6%（P＜0.05）。

结论

术前NLR、PLR 及SII 水平与全身麻醉下结直肠癌根治术后并发肠梗阻密切相关，可作为预测术后肠梗阻的潜在指标，为临床早期干预提供参考依据。

关键词: 结直肠癌, 肠梗阻, 中性粒细胞/淋巴细胞比值, 血小板/淋巴细胞比值, 全身免疫炎症指数

Objective

To investigate the predictive value of preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immunoinflammatory index (SII)for intestinal obstruction after radical resection of colorectal cancer under general anesthesia.

Methods

A total of 200 patients who underwent radical resection of colorectal cancer under general anesthesia in Baoji Central Hospital from January 2023 to January 2025 were selected as the study objects, according to whether postoperative intestinal obstruction occurred, they were divided into postoperative intestinal obstruction (POI) group (n=30) and non-POI group (n=170).Age, gender, body mass index, comorbidities(hypertension, diabetes, coronary heart disease), tumor site, tumor TNM stage, pathological type, degree of differentiation, tumor size, operation time, preoperative NLR, PLR and SII levels were collected.Logistic regression analysis was used to screen the influencing factors of intestinal obstruction after radical resection of colorectal cancer under general anesthesia, and receiver operating characteristics (ROC) curve was drawn to evaluate the predictive value of NLR, PLR and SII levels in postoperative intestinal obstruction.

Results

There was no significant difference in age, sex, body mass index, comorbidities,tumor site, pathological type, differentiation degree, tumor size and operation time between the two groups(P>0.05).The proportion of TNM stage Ⅲ in POI group was higher than that in non-POI group, and preoperative NLR, PLR and SII levels were higher than those in non-POI group (P<0.05).Logistic regression analysis showed that TNM stage Ⅲ, preoperative NLR, PLR and SII levels were all risk factors for postoperative intestinal obstruction after radical resection of colorectal cancer under general anesthesia(P<0.05).ROC curve analysis results showed that the AUC of preoperative NLR, PLR and SII predicting intestinal obstruction after radical resection of colorectal cancer under general anesthesia were 0.756 (95%CI 0.652-0.860), 0.836 (95% CI 0.739-0.932) and 0.752 (95% CI 0.650-0.853), the corresponding sensitivities were 56.7%, 76.7% and 46.7%, and the specificities were 90.0%, 87.1% and 97.6% (P<0.05).

Conclusion

The preoperative levels of NLR, PLR, and SII are closely related to the occurrence of intestinal obstruction after radical resection of colorectal cancer under general anesthesia, which can be used as potential indicators to predict postoperative intestinal obstruction and provide reference for early clinical intervention.

Key words: Colorectal cancer, Intestinal obstruction, Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio, Systemic immunoinflammatory index

表1 全身麻醉下结直肠癌根治术后并发肠梗阻的单因素分析

因素	组别		χ ²/t值	P值
因素	POI组(n=30)	非POI 组(n=170)	χ ²/t值	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	64.23±4.54	63.98±4.65	0.272	0.786
性别(例)			0.006	0.936
男	17	95
女	13	75
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	21.80±2.31	21.64±2.12	0.376	0.707
合并症(例)
高血压	7	35	0.116	0.734
糖尿病	5	26	0.037	0.848
冠心病病	3	22	0.207	0.653
肿瘤部位(例)			0.144	0.704
结肠	16	97
直肠	14	73
肿瘤TNM 分期(例)			6.544	0.038
I期	5	45
Ⅱ期	8	70
Ⅲ期	17	55
病理类型(例)			0.010	0.919
腺癌	27	154
其他	3	16
分化程度(例)			0.015	0.903
低分化	18	104
中、高分化	12	66
肿瘤大小(例)			0.113	0.736
＜5 cm	16	85
≥5 cm	14	85
手术时间(例)
＜3 h	13	75	0.006	0.936
≥3 h	17	95
术前NLR( $\overset{ˉ}{x}$ ± s )	4.35±1.24	3.30±0.89	5.585	0.000
术前PLR( $\overset{ˉ}{x}$ ± s )	150.05±35.50	110.04±20.25	8.738	0.000
术前SII ( $\overset{ˉ}{x}$ ± s )	573.84±70.20	512.07±50.46	5.797	0.000

表1 全身麻醉下结直肠癌根治术后并发肠梗阻的单因素分析

因素	组别		χ ²/t值	P值
因素	POI组(n=30)	非POI 组(n=170)	χ ²/t值	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	64.23±4.54	63.98±4.65	0.272	0.786
性别(例)			0.006	0.936
男	17	95
女	13	75
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	21.80±2.31	21.64±2.12	0.376	0.707
合并症(例)
高血压	7	35	0.116	0.734
糖尿病	5	26	0.037	0.848
冠心病病	3	22	0.207	0.653
肿瘤部位(例)			0.144	0.704
结肠	16	97
直肠	14	73
肿瘤TNM 分期(例)			6.544	0.038
I期	5	45
Ⅱ期	8	70
Ⅲ期	17	55
病理类型(例)			0.010	0.919
腺癌	27	154
其他	3	16
分化程度(例)			0.015	0.903
低分化	18	104
中、高分化	12	66
肿瘤大小(例)			0.113	0.736
＜5 cm	16	85
≥5 cm	14	85
手术时间(例)
＜3 h	13	75	0.006	0.936
≥3 h	17	95
术前NLR( $\overset{ˉ}{x}$ ± s )	4.35±1.24	3.30±0.89	5.585	0.000
术前PLR( $\overset{ˉ}{x}$ ± s )	150.05±35.50	110.04±20.25	8.738	0.000
术前SII ( $\overset{ˉ}{x}$ ± s )	573.84±70.20	512.07±50.46	5.797	0.000

表2 自变量赋值表

自变量	赋值
肿瘤TNM 分期	0：I期，1：Ⅱ期，2：Ⅲ期
术前NLR	取连续变量
术前PLR	取连续变量
术前SII	取连续变量

表2 自变量赋值表

自变量	赋值
肿瘤TNM 分期	0：I期，1：Ⅱ期，2：Ⅲ期
术前NLR	取连续变量
术前PLR	取连续变量
术前SII	取连续变量

表3 全身麻醉下结直肠癌根治术后并发肠梗阻的多因素Logistic 回归分析

因素	β	S.E.	95% CI	Wald χ ²	OR	P
肿瘤TNM 分期Ⅲ期	1.770	0.450	2.430～14.182	15.471	5.871	0.034
术前NLR	1.385	0.543	1.378～11.580	6.506	3.995	0.021
术前PLR	1.423	0.562	1.379～12.485	6.411	4.150	0.011
术前SII	1.090	0.514	1.086～8.145	4.497	2.974	0.034

表3 全身麻醉下结直肠癌根治术后并发肠梗阻的多因素Logistic 回归分析

因素	β	S.E.	95% CI	Wald χ ²	OR	P
肿瘤TNM 分期Ⅲ期	1.770	0.450	2.430～14.182	15.471	5.871	0.034
术前NLR	1.385	0.543	1.378～11.580	6.506	3.995	0.021
术前PLR	1.423	0.562	1.379～12.485	6.411	4.150	0.011
术前SII	1.090	0.514	1.086～8.145	4.497	2.974	0.034

图1 预测全身麻醉下结直肠癌根治术后并发肠梗阻的ROC 曲线分析注：NLR 中性粒细胞/淋巴细胞比值；PLR 血小板/淋巴细胞比值；SII全身免疫炎症指数

表4 术前NLR、PLR 及SII 对全身麻醉下结直肠癌根治术后并发肠梗阻的预测价值

变量	AUC	95% CI	敏感度(%)	特异性(%)
术前NLR	0.756	0.652～0.860	0.567	0.900
术前PLR	0.836	0.739～0.932	0.767	0.871
术前SII	0.752	0.650～0.853	0.467	0.976

表4 术前NLR、PLR 及SII 对全身麻醉下结直肠癌根治术后并发肠梗阻的预测价值

变量	AUC	95% CI	敏感度(%)	特异性(%)
术前NLR	0.756	0.652～0.860	0.567	0.900
术前PLR	0.836	0.739～0.932	0.767	0.871
术前SII	0.752	0.650～0.853	0.467	0.976

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Predictive value of preoperative NLR, PLR and SII levels for intestinal obstruction after radical resection of colorectal cancer under general anesthesia

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Predictive value of preoperative NLR, PLR and SII levels for intestinal obstruction after radical resection of colorectal cancer under general anesthesia