Abstract:

Objective　To explore the relationships between lymphocyte to monocyte ratio (LMR), mean platelet volume to lymphocyte ratio (MPVLR) and radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer. Methods　A total of 102 patients with stage Ⅲ lung cancer who received radical radiotherapy in the Department of Radiotherapy, Shaanxi Provincial Cancer Hospital from February 2020 to March 2023 were selected as the study objects. There were 85 males and 17 females, aged 32-76 (51.17±8.27) years, with a body mass index (BMI) of 22.46-24.52 (23.06±1.57) kg/m². The monocyte count, mean platelet volume, and lymphocyte count before radiotherapy were measured by automatic blood analyzer, and the LMR and MPVLR values were calculated according to the test results. The patients were followed up for 3 months and were divided into an occurrence group (23 cases) and a non-occurrence group (79 cases) according to whether they developed radiation pneumonia. The receiver operating characteristic curve (ROC) was used to evaluate the predictive values of peripheral blood LMR and MPVLR for radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer. Multivariate logistic regression analysis was used to explore the influencing factors of radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer. Independent sample t test and χ² test were used. Results　The LMR and MPVLR before radiotherapy in the occurrence group were lower than those in the non-occurrence group (both P<0.05). The areas under the curves (AUCs) (95%CI) of peripheral blood LMR and MPVLR before radiotherapy for predicting radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer were 0.745 (0.695-0.791) and 0.862 (0.812-0.907), respectively, and the AUC (95%CI) of the combined detection was 0.916 (0.871-0.966). The proportions of the patients with central gross type, tumor diameter ≥5 cm, and total dose ≥60 Gy in the occurrence group were higher than those in the non-occurrence group (all P<0.05). Multivariate logistic regression analysis showed that total radiation dose (OR=2.217, 95%CI: 1.452-3.385), tumor diameter (OR=2.368, 95%CI: 1.409-3.980), decreased LMR (OR=2.649, 95%CI: 1.658-4.231), and elevated MPVLR (OR=3.177, 95%CI: 1.868-5.404) were risk factors for radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer (all P<0.05). Conclusions　Low expression of LMR and high expression of MPVLR in the peripheral blood of lung cancer patients with radiation pneumonia after radical radiotherapy are observed, and LMR and MPVLR have a certain relationship with the occurrence of radiation pneumonia after radical radiotherapy. Both of them are influencing factors for the occurrence of radiation pneumonia after radical radiotherapy for lung cancer, and their combined detection has a higher value in the evaluation of radiation pneumonia after radical radiotherapy for lung cancer.

Key words:

Lymphocyte to monocyte ratio, Mean platelet volume to lymphocyte ratio, Lung cancer, Radiotherapy, Radiation pneumonia

摘要：

目的　探讨淋巴细胞与单核细胞比值（LMR）、平均血小板体积与淋巴细胞比值（MPVLR）与Ⅲ期肺癌患者根治性放疗后放射性肺炎的关系。方法　选取2020年2月至2023年3月在陕西省肿瘤医院放疗科行根治性放疗的102例Ⅲ期肺癌患者作为研究对象。男85例、女17例；年龄32～76（51.17±8.27）岁；体重指数（BMI）22.46～24.52（23.06±1.57）kg/m²。采用全自动血液分析仪检测放疗前单核细胞计数、平均血小板体积、淋巴细胞计数，根据检测结果计算LMR、MPVLR。随访3个月，根据是否发生放射性肺炎将患者分为发生组（23例）和未发生组（79例）。采用受试者操作特征曲线（ROC）评估外周血LMR、MPVLR对Ⅲ期肺癌患者根治性放疗后放射性肺炎的预测价值，采用多因素logistic回归分析探讨Ⅲ期肺癌患者根治性放疗后发生放射性肺炎的影响因素。采用独立样本t检验和χ²检验。结果　发生组放疗前LMR低于未发生组，MPVLR高于未发生组（均P<0.05）；放疗前外周血LMR、MPVLR预测Ⅲ期肺癌患者根治性放疗后放射性肺炎的曲线下面积（AUC）（95%CI）分别为0.745（0.695～0.791）、0.862（0.812～0.907），两者联合检测的AUC（95%CI）为0.916（0.871～0.966）。发生组大体类型中央、肿瘤长径≥5 cm、放射总剂量≥60 Gy患者比例均高于未发生组（均P<0.05）。多因素logistic回归分析显示，放射总剂量（OR=2.217，95%CI：1.452～3.385）、肿瘤长径（OR=2.368，95%CI：1.409～3.980）、LMR降低（OR=2.649，95%CI：1.658～4.231）、MPVLR升高（OR=3.177，95%CI：1.868～5.404）是Ⅲ期肺癌患者根治性放疗后发生放射性肺炎的危险因素（均P<0.05）。结论　外周血LMR在肺癌根治性放疗后放射性肺炎患者中呈低表达，MPVLR呈高表达，两者与肺癌根治性放疗后发生放射性肺炎存在一定的关系。两者均是肺癌根治性放疗后发生放射性肺炎的影响因素，两者联合检测对肺癌根治性放疗后发生放射性肺炎的评估价值更高。

关键词:

淋巴细胞与单核细胞比值, 平均血小板体积与淋巴细胞比值, 肺癌, 放疗, 放射性肺炎