目的 探讨中性粒细胞-淋巴细胞比值(NLR)和老年营养风险指数(GNRI)用于预测结直肠癌患者预后的价值。 方 法 选取 2019 年 5 月至 2021 年 1 月于武汉市红十字会医院诊治且随访至 2023 年 12 月的结直肠癌患者 103 例作为研究对 象,设立为结直肠癌组,同期选取 52 例健康体检者设立为对照组。 对比 NLR、GNRI 变化;比较不同病理特征结直肠癌患者的 NLR、GNRI 变化;Kendall′s tau-b 相关性检验分析 NLR、GNRI 与临床特征的相关性;采用 Cox 回归风险模型分析 NLR、GNRI 对结直肠癌患者预后的影响;采用 Logistic 回归构建 NLR、GNRI 两项联合参数,并绘制受试者操作特征(ROC)曲线分析 NLR、 GNRI 及两项联合预测预后的效能。 结果 结直肠癌组的 NLR、GNRI 低于对照组(P<0. 05)。 103 例结直肠癌患者无进展生存 期为(30. 98±8. 27)个月,总生存期为(32. 91±6. 09) 个月,3 年无进展生存率为 71. 84% ( 74 / 103),3 年总生存率为 77. 67% (80 / 103)。 不同年龄、分化程度、临床分期、淋巴结转移、白蛋白的结直肠癌患者 NLR、GNRI 比较,差异具有统计学意义(P< 0. 05)。 Kendall′s tau-b 相关性分析显示,NLR 与结直肠癌患者的年龄、分化程度、临床分期、淋巴结转移呈正相关,与白蛋白 水平呈负相关(P<0. 05);GNRI 与结直肠癌患者年龄、分化程度、临床分期呈负相关,与白蛋白水平呈正相关(P<0. 05)。 Cox 回归风险模型分析显示,NLR 升高和 GNRI 下降为结直肠癌患者 3 年无进展生存率及总生存率的独立影响因素(P<0. 05)。 ROC 曲线分析显示,NLR、GNR 及两项联合预测结直肠癌患者预后的 AUC 值分别为 0. 732、0. 693、0. 808(P<0. 05);敏感度分 别为 69. 60%、60. 90%、65. 20%;特异度分别为 93. 70%、96. 20%、98. 80%。 结论 NLR 升高和 GNRI 下降会对结直肠癌患者预 后产生不利影响,动态观察其变化有利于为临床治疗和预后评估提供指导。

Objective To investigate the value of neutrophil-lymphocyte ratio NLR and geriatric Nutritional risk index GNRI in predicting the prognosis of patients with colorectal cancer. Method A total of 103 patients with colorectal cancer who were diagnosed and treated in Wuhan Red Cross Hospital from May 2019 to January 2021 and followed up to December 2023 were selected as the study objects and set as the colorectal cancer group and 52 healthy subjects were selected as the control group during the same period. Compare the changes of NLR and GNRI. The changes of NLR and GNRI in colorectal cancer patients with different pathological characteristics were compared. Kendall′ s tau - b method was used to analyze the correlation between NLR GNRI and clinical features. Cox regression risk model was used to analyze the effects of NLR and GNRI on the prognosis of colorectal cancer patients. The combined parameters of NLR and GNRI were constructed by Logistic regression and receiver operating characteristic ROC curves were drawn to analyze the efficacy of NLR GNRI and the combined prediction of prognosis. Result The NLR and GNRI in colorectal cancer group were lower than those in control group P<0. 05 . The progression-free survival of 103 patients with colorectal cancer was 30. 98±8. 27 the overall survival was 32. 91±6. 09 months the 3-year progression-free survival rate was 71. 84% 74 / 103 and the 3-year overall survival rate was 77. 67% 80 / 103 . There were statistically significant differences in NLR and GNRI among colorectal cancer patients with different age differentiation degree clinical stage lymph node metastasis and albumin P< 0. 05 . Kendall′s tau-b correlation analysis showed that NLR was positively correlated with age differentiation clinical stage and lymph node metastasis of colorectal cancer patients and negatively correlated with albumin P<0. 05 . GNRI was negatively correlated with age differentiation and clinical stage of colorectal cancer patients and positively correlated with albumin P<0. 05 . Cox regression risk model analysis showed that the increase of NLR and the decrease of GNRI were independent influencing factors for 3-year disease-free survival and overall survival of colorectal cancer patients P<0. 05 . ROC curve analysis showed that the AUC values of NLR GNR and the combination of NLR and GNR were 0. 732 0. 693 and 0. 808 respectively P<0. 05. Sensitivity was 69. 60% 60. 90% 65. 20%. The specificity was 93. 70% 96. 20% and 98. 80% . Conclusion The increase of NLR and the decrease of GNRI have adverse effects on the prognosis of colorectal cancer patients and dynamic observation of their changes is conducive to providing guidance for clinical treatment and prognosis assessment.