交通医学

目的：评估15项血液指标比值对肝炎、肝硬化、肝癌的诊断价值。方法 ：回顾性分析87例肝硬化、56例肝癌、58例肝炎及健康体检者15项血液指标比值：甲胎蛋白与癌胚抗原比值（alpha-fetoprotein to carcinoembryonic antigen ratio,ACR）、甲胎蛋白与白细胞比值（alpha-fetoprotein to white blood cell ratio,AWR）、甲胎蛋白与淋巴细胞比值（alpha-fetoprotein to lymphocyte ratio,ALR）、甲胎蛋白与血小板比值（alpha-fetoprotein to platelet ratio,APR）、甲胎蛋白与中性粒细胞比值（alpha-fetoprotein to neutrophil ratio,ANR）、癌胚抗原与白细胞比值（carcinoembryonic antigen to white blood cell ratio,CWR）、癌胚抗原与淋巴细胞比值（carcinoembryonic antigen to lymphocyte ratio,CLR）、癌胚抗原与血小板比值（carcinoembryonic antigen to platelet ratio,CPR）、癌胚抗原与中性粒细胞比值（carcinoembryonic antigen to neutrophil ratio,CNR）、白细胞与淋巴细胞比值（white blood cell to lymphocyte ratio,WLR）、白细胞与血小板比值（white blood cell to platelet ratio,WPR）、白细胞与中性粒细胞比值（white blood cell to neutrophil ratio,WNR）、淋巴细胞与血小板比值（lymphocyte to platelet ratio,LPR）、淋巴细胞与中性粒细胞比值（lymphocyte to neutrophil ratio,LNR）、血小板与中性粒细胞比值（platelet to neutrophil ratio,PNR），分析各比值诊断肝炎、肝硬化、肝癌的价值。结果：除WNR外，4组ACR、AWR、ALR、APR、ANR、CWR、CLR、CPR、CNR、WLR、WPR、LPR、LNR、PNR的差异均有统计学意义（P<0.05）。Logistic回归显示，较高水平CPR是肝癌发生的保护因素（P<0.05）。ROC曲线分析显示，WPR诊断肝炎的曲线下面积（area under curve,AUC）为0.754，敏感度为0.966;CPR、WPR、LPR诊断肝硬化的AUC分别为0.987、0.997、1.000，敏感度均为1.000；三者诊断肝癌的AUC分别为0.778、0.792、0.860，敏感度分别为0.964、1.000、0.928。结论：WPR、CPR、LPR是诊断效能最优的核心指标，WPR对肝炎，CPR、WPR、LPR对肝硬化、肝癌具有较高诊断价值。

Objective: To evaluate the diagnostic value of 15 blood index ratios for hepatitis, liver cirrhosis and liver cancer. Methods: A retrospective analysis was conducted on the ratios of 15 blood indicators in 87 cases of liver cirrhosis,56 cases of liver cancer, 58 cases of hepatitis and healthy individuals undergoing physical examinations. The ratio of alpha-fetoprotein to carcinoembryonic antigen ratio(ACR), alpha-fetoprotein to white blood cell ratio(AWR), alpha-fetoprotein to lymphocyte ratio(ALR), alpha-fetoprotein to platelet ratio(APR), alpha-fetoprotein to neutrophil ratio(ANR), carcinoembryonic antigen to white blood cell ratio(CWR), carcinoembryonic antigen to lymphocyte ratio(CLR), carcinoembryonic antigen to platelet ratio(CPR), carcinoembryonic antigen to neutrophil ratio(CNR), white blood cell to lymphocyte ratio(WLR), white blood cell to platelet ratio(WPR), white blood cell to neutrophil ratio(WNR), lymphocyte to platelet ratio(LPR),lymphocyte to neutrophil ratio(LNR) and platelet to neutrophil ratio(PNR). Analyze the diagnostic value of each ratio for hepatitis, liver cirrhosis and liver cancer. Results: There were statistically significant differences in the ACR, AWR, ALR,APR, ANR, CWR, CLR, CPR, CNR, WLR, WPR, LPR, LNR and PNR among the four groups(P<0.05), but there was no significant difference in the WNR among the four groups(P>0.05). Logistic regression analysis revealed that higher CPR level was a protective factor for the occurrence of liver cancer(P<0.05). The receiver operating characteristic(ROC) curve analysis showed that the area under curve(AUC) for WPR in diagnosing hepatitis was 0.754, with a sensitivity of 0.966. The AUC values of CPR, WPR, and LPR for diagnosing liver cirrhosis were 0.987, 0.997, and 1.000 respectively, with all sensitivities being1.000. The AUC values for diagnosing liver cancer were 0.778, 0.792 and 0.860 respectively, with sensitivities of 0.964,1.000 and 0.928. Conclusion: WPR, CPR, and LPR are the core indicators with the best diagnostic efficacy. WPR has high diagnostic value for hepatitis, while CPR, WPR, and LPR have high diagnostic value for liver cirrhosis and liver cancer.