【摘要】 目的 探究不同预后结直肠癌伴肝转移患者中性粒细胞和淋巴细胞绝对值比值(neutrophil to lymphocyte ratio, NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio, PLR)、免疫指标、营养学指标表达特征，并建立预后评估模型，检测该模型预后评估效能。方法 选取2023年1月—2024年5月河北北方学院附属第一医院收治的结直肠伴肝转移患者104例作为研究对象，根据疗效分为预后良好组(n=50)及预后不良组(n=54),观察比较患者基线资料、NLR、单核细胞和淋巴细胞绝对值比值(monocyte to lymphocyte ratio, MLR)、PLR、白细胞与淋巴细胞比值(white blood cell to lymphocyte ratio, WLR)、营养学指标。采用多元Cox回归模型进行生存分析NLR、MLR、PLR、WLR、营养学指标与患者生存期相关性，使用Logistic回归分析预后独立危险因素并建立模型，另选取同期我院结直肠伴肝转移患者112例作为验证集用于预测模型效能验证，绘制受试者工作特征(receiver operating characteristic, ROC)曲线评估模型预后评估效能。结果 预后不良组年龄[(64.66±11.67)岁vs.(55.46±7.38)岁]、NLR(3.37±0.35 vs. 3.06±0.31)、MLR(0.35±0.03 vs. 0.29±0.03)、PLR(175.08±20.95 vs. 165.44±20.31)、WLR(4.97±0.91 vs. 4.29±0.82)、主观全面评定法(subjective global assessment, SGA)评分[(5.25±0.86)分vs.(4.32±0.81)分]水平高于预后良好组，体重[(58.18±6.56)kg vs.(68.27±10.71)kg]、体重指数(body mass index, BMI)(21.64±2.68 vs. 24.34±3.02)、血清总蛋白(total protein, TP)[(58.00±5.08)g/L vs.(63.94±5.65)g/L]、转铁蛋白(transferrin, TF)[(1.19±0.23)μmol/L vs.(1.78±0.29)μmol/L]、前白蛋白(prealbumin, PA)[(0.16±0.07)g/L vs.(0.25±0.09)g/L]、白蛋白(albumin, ALB)[(36.42±2.24)g/L vs.(41.48±2.70)g/L]、骨骼肌质量指数(skeletal muscle mass index, SMI)(5.53±0.51 vs. 6.38±0.57)、微型营养评价(mini nutritional assessment, MNA)评分[(11.40±3.67)分vs.(15.29±4.26)分]低于预后良好组；ALB、TP、TF、MNA评分与患者生存期呈正相关，NLR、MLR、PLR、WLR、SGA评分与患者生存期呈负相关；ALB、PA、TP、TF、SMI、MNA评分、NLR、MLR、PLR、WLR、SGA评分是结直肠癌伴肝转移患者预后的独立影响因素(P<0.05);多因素预测模型ROC曲线的曲线下面积为0.920,预测敏感度为81.25%,预测特异度为75.89%,标准误为0.022,95%CI:0.876～0.964,具有较高预测效能。结论 结直肠癌伴肝转移患者预后与其NLR、PLR、免疫指标、营养学指标表达均存在相关性，ALB、PA、TP、TF、SMI、MNA评分、NLR、MLR、PLR、WLR、SGA评分是结直肠癌伴肝转移患者预后的独立影响因素，基于NLR、PLR、免疫指标联合营养学指标建立预后预测模型对预后评估具有较高的效能。更多还原

【Abstract】 Objective To explore the expression characteristics of neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR), immune indicators and nutritional indicators in colorectal cancer(CRC) patients with liver metastasis with different prognoses, to establish a prognostic evaluation model, and to assess its prognostic efficacy. Methods A total of 104 CRC patients with liver metastasis admitted to the First Affiliated Hospital of Hebei North University from January 2023 to May 2024 were selected. According to the efficacy, they were divided into the good prognosis group(n=50) and the poor prognosis group(n=54). The baseline data, NLR and monocyte to lymphocyte ratio(MLR), PLR, white blood cell to lymphocyte ratio(WLR), and nutritional indicators of the patients were observed and compared. Multivariate Cox regression model was used to analyze the correlation between NLR, MLR, PLR, WLR and nutritional indicators and the survival of patients. Logistic regression was used to analyze the independent risk factors of prognosis and establish the model. In addition, 112 CRC patients with liver metastasis in our hospital during the same period were selected as the validation set for efficacy validation of the prediction model. The receiver operating characteristic(ROC) curve was used to evaluate the prognostic efficacy of the model. Results Age was [(64.66±11.67) years vs.(55.46±7.38) years], NLR(3.37±0.35 vs. 3.06±0.31), MLR(0.35±0.03 vs. 0.29±0.03), PLR(175.08±20.95 vs. 165.44±20.31), WLR(4.97±0.91 vs.4.29±0.82), and subjective global assessment(SGA) score(5.25±0.86 vs. 4.32 ±0.81) were higher in the poor prognosis group than in the good prognosis group, whereas body weight [(58.18±6.56) kg vs.(68.27±10.71) kg], body mass index(BMI)(21.64±2.68 vs. 24.34±3.02), serum total protein(TP) [(58.00±5.08) g/L vs.(63.94±5.65) g/L], transferrin(TF) [(1.19±0.23) μmol/L vs.(1.78±0.29) μmol/L], prealbumin(PA) [(0.16±0.07) g/L vs.(0.25±0.09) g/L], albumin(ALB) [(36.42±2.24) g/L vs.(41.48±2.70) g/L], skeletal muscle mass index(SMI)(5.53±0.51 vs. 6.38±0.57), mini nutritional assessment(MNA) score(11.40±3.67 vs. 15.29±4.26) in the poor prognosis group was lower than that in the good prognosis group. The scores of ALB, TP, TF and MNA were positively correlated with the survival time of patients, while NLR, MLR, PLR, WLR and SGA score were negatively correlated with the survival time of patients. ALB, PA, TP, TF, SMI, MNA score, NLR, MLR, PLR, WLR and SGA score were independent influencing factors for the prognosis of CRC patients with liver metastasis(P<0.05). The area under the ROC curve(AUC) of the multivariate prediction model was 0.920, with the prediction sensitivity of 81.25%, the prediction specificity of 75.89%, the standard deviation of 0.022, and the 95%CI of 0.876-0.964, which had a high prediction efficacy. Conclusion The prognosis of CRC patients with liver metastasis is correlated with the expression of NLR, PLR, immune indicators and nutritional indicators. ALB, PA, TP, TF, SMI, MNA score, NLR, MLR, PLR, WLR and SGA score are independent prognostic factors for CRC patients with liver metastasis. The prognostic prediction model based on NLR, PLR, immune indicators combined with nutritional indicators has high efficacy in evaluating the prognosis of patients.更多还原