摘要目的 分析术前中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)联合三种共识评估分支型胰腺导管内乳头状黏液性肿瘤(BD-IPMN)在患者手术决策中的差异.方法 回顾性分析复旦大学附属中山医院从2008年1月至2015年12月手术切除的51例BD-IPMN患者的临床资料. 结果 三种共识在推荐随访者之间差异有统计学意义(P＜0.05),在良恶性BD-IPMN鉴别诊断中NLR和PLR曲线下面积(AUC)分别为0.686和0.692,最佳界值为2.64,92.56.各共识在联合PLR后特异性和阳性预测值(PPV)都有所提升,其中福冈共识在联合PLR后能在保持92.9％的灵敏度情况下显著提高其特异性(70.3％)和PPV(54.2％).结论 NLR≥2.64和PLR≥92.56可能是预测BD-IPMN恶变的因素,PLR联合福冈共识能提高判断BD-IPMN良恶性的准确性.

abstractsObjective To analyze the difference among the 3 guidehnes used to make surgical decision for branch duct intraductal papillary mucinous neoplasm (BD-IPMN),then the guidelines were combined with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) respectively for further analysis.Methods Clinical data of 51 appropriate BD-IPMN patients who underwent surgical resection from January 2008 to December 2015 was retrospectively analyzed.Results The significant difference was exist in the consensus for followup criterion (P ＜ 0.05).The preoperative NLR and PLR were helpful for the differential diagnosis between malignant and benign BD-IPMN,because the receiver operating characteristic curve (ROC) of NLR and PLR for prediction were 0.686 and 0.692,and the best boundary values were 2.64,92.56 respectively.The consensus combined with PLR could improve the specificity and positive predictive value (PPV),besides,the specificity and PPV could achieve 70.3％,54.2％ respectively while the sensitivity (92.9％) still remained at an ideal level after international consensus guideline combined with PLR.Conclusions NLR ≥ 2.64 and PLR ≥ 92.56 were predictive markers for the presence of BD-IPMN associated invasive tumor.The addition of PLR as a criterion to the international consensus guideline improved the accuracy of international consensus guidelines in estimating invasive BD-IPMN.