目的：探讨肝内胆管癌（intrahepatic cholangiocarcinoma，ICCA）围手术期外周血中性粒细胞与淋巴细胞比率 （neutrophil-to-lymphocyte ratio，NLR）和血小板与淋巴细胞比率（platelet-to-lymphocyte ratio，PLR）对患者预后的预测价值。方 法：收集2015年1月至2018年1月在上海市松江区中心医院接受肝切除术治疗的ICCA患者97例作为ICCA组，选择同期在本院做 健康体检的志愿者100例作为正常对照组。检测两组受试者术前1 d、术后3 d和7 d外周血的NLR、PLR，采用单因素、多因素分析 ICCA患者术后随访期死亡的危险因素，采用Kaplan-Meier生存曲线分析术后3 d的NLR和PLR对ICCA患者术后生存时间的影响， 采用受试者工作特征曲线（receiver operating characteristic curve，ROC）分析术后3 d的NLR和PLR水平对患者术后随访期死亡的预 测价值。结果：ICCA组患者术前1 d、术后3和7 d外周血的NLR、PLR 均高于正常对照组（均P<0.05），术前1 d和7 d外周血NLR、 PLR差异无统计学意义（P>0.05）术后3 d外周血NLR、PLR水平最高（P<0.05）。多发肿瘤、合并淋巴结转移、TNM分期Ⅲ~Ⅳ、CA199 水平增高、术后3 d的NLR和PLR较高分别是ICCA患者随访期死亡的独立危险因素（均P<0.05）。ROC曲线显示，术后3 d的NLR 和PLR高低对ICCA患者术后生存时间具有预测价值。Kaplan-Meier生存曲线显示，低NLR（[ 50.32±3.69）vs（30.12±2.36）个月]和 低PLR（[ 53.6±3.75）vs（37.6±2.96）个月]患者生存时间均长于高NLR和PLR的ICCA患者（均P<0.05）。结论：ICCA术后3 d的NLR 和PLR异常增高是患者肝切除术后死亡的独立危险因素，其对患者生存时间具有早期预测价值。

Objective: To investigate the predictive value of peripheral blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to[1]lymphocyte ratio (PLR) in perioperative period on the prognosis of patients with intrahepatic cholangiocarcinoma (ICCA). Methods: Ninety-seven cases of ICCA patients underwent liver resection surgery in Songjiang District Central Hospital from January 2015 to January 2018 were chosen as the ICCA group, and 100 healthy volunteers who underwent physical examination in the hospital during the same period were selected as the control group. The NLR and PLR on preoperative day 1, postoperative day 3 and day 7 were compared between the two groups. Univariate and multivariate analyses were performed to determine the risk factors for mortality during postoperative follow-up in patients with ICCA. Kaplan-Meier survival curve was used to analyze the influence of postoperative day 3 NLR and PLR on the survival time of patients with ICCA. ROC curve was used to analyze the predictive value of postoperative day 3 NLR and PLR on the mortality during postoperative follow-up. Results: Peripheral blood NLR and PLR in the ICCA group were higher than those in the normal control group on preoperative day 1 and postoperative day 3, 7 (all P<0.05). In the ICCA group, the peripheral blood NLR and PLR on preoperative day 1 and postoperative day 7 showed no statistical difference (P>0.05); however, the levels on postoperative day 3 was the highest (P<0.05). Multiple tumors, lymph node metastasis, TNM staging Ⅲ - Ⅳ , increased carbohydrate antigen 199 (CA199) level and higher NLR and PLR on postoperative day 3 were the independent risk factors of mortality during postoperative follow-up in ICCA patients (all P<0.05). The ROC showed that NLR and PLR on postoperative day 3 had predictive value for the survival time of patients with ICCA. Kaplan-Meier survival curve showed that the survival time of patients in low NLR group was longer than those in high NLR group [(50.32±3.69) months vs (30.12±2.36) months], and the survival time of patients in low PLR group was longer than those in high PLR group [(53.6±3.75) months vs (37.6±2.96) months] (all P<0.05). Conclusion: Abnormal elevation in NLR and PLR on postoperative day 3 is an independent risk factor for death after liver resection surgery in patients with ICCA, which has early predictive value for patients’survival.

国家自然科学基金资助项目（No.81272534，No.30872510）