【摘要】 目的 识别头颈癌（head and neck cancer,HNC）患者放疗期间中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）的变化轨迹，分析NLR的变化轨迹与重度放射性口腔黏膜炎（radiotherapy-induced oral mucositis,RIOM）之间的关系。方法 采用回顾性纵向研究设计，选取2022年7月至2023年8月在中南大学湘雅医院收治的180例接受放疗的HNC患者作为研究对象。分别在放疗前（T0）、放疗开始后1周（T1）、放疗开始后2周（T2）、放疗开始后3周（T3）、放疗开始后4周（T4）、放疗开始后5周（T5）和放疗开始后6周（T6）收集HNC放疗患者的中性粒细胞计数和淋巴细胞计数，并计算7个时间点的NLR。使用潜类增长模型和增长混合模型识别最佳的NLR轨迹亚组，采用Logistic回归分析判断NLR的轨迹亚组与重度RIOM之间的关系。结果 NLR变化轨迹存在基线低水平-快速增长组（Class-1组）和基线高水平-快速增长组（Class-2组）2个潜在亚组。Logistic回归分析显示，Class-2组发生重度RIOM的危险性是Class-1组的3.67倍。在控制混杂因素的干扰后，NLR轨迹亚组仍是发生重度RIOM的危险因素，且重度RIOM发生风险从3.67倍增加到27.0倍。结论 NLR能够作为预测重度RIOM的生物标志物。NLR较高的人群发生重度RIOM的风险更高。更多还原

【Abstract】 Objective To identify the neutrophil to lymphocyte ratio(NLR) trajectories in head and neck cancer(HNC) patients during radiotherapy and to analyze the relationship between NLR trajectories and severe radiotherapy-induced oral mucositis(RIOM).Method A retrospective longitudinal study design was used.180 cases of HNC patients who received radiotherapy in Xiangya Hospital of Central South University from July 2022 to August 2023 were enrolled for the research.Neutrophil counts and lymphocyte counts were collected at baseline before radiotherapy(T0) and 1 week after beginning radiotherapy(T1),2 weeks after beginning radiotherapy(T2),3 weeks after beginning radiotherapy(T3),4 weeks after beginning radiotherapy(T4),5 weeks after beginning radiotherapy(T5),6 weeks after beginning radiotherapy(T6),respectively.NLR was calculated at the seven time points.The optimal NLR trajectory subgroups were identified using the latent class growth model and growth mixed model.Logistic regression analysis was used to determine the relationship between the NLR trajectory subgroups and severe RIOM. Result There were two potential subgroups of NLR trajectorics which were baseline low-level with rapid growth group(Class-1 group) and baseline high-level with rapid growth group(Class-2 group).The logistic regression analysis showed that the risk of severe RIOM in the Class-2 group was 3.67times higher than that in the Class-1 group.After controlling for the interference of confounding factors,NLR trajectory subgroups was still a risk factor for severe RIOM,and the risk of severe RIOM was increased from 3.67 times to 27.0 times.Conclusion NLR can be used as a biomarker to predict severe RIOM.The population with higher NLR value has a higher risk of severe RIOM.更多还原