[摘 要] 目的：探讨中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、乳酸脱氢酶（LDH）联合检测对转移 性胃癌（MGC）患者免疫检查点抑制剂（ICI）治疗效果和预后预测的价值。方法：本研究回顾性分析了在福建医科大学附属南平 第一医院治疗的88例MGC患者免疫治疗前和治疗后的外周血液学相关指标，患者近期治疗疗效根据实体瘤反应评价标准进行 评估，通过χ2 检验进行分析和比较两组间疾病控制率（DCR）和客观缓解率（ORR）的差异及PD-L1表达差异及组间临床特征差 异。生存分析采用Kaplan-Meier法进行单因素分析，组间差异的比较则采用Log-Rank检验，单因素分析采用Cox比例风险回归 模型进行。结果：免疫治疗后 NLR3、NLR4、PLR2、PLR3、PLR4、LDH2、LDH3 较治疗前均显著下降（均P < 0.05）。完全缓 解（CR） + 部分缓解（PR）组与疾病进展（PD）组患者治疗前的NLR1、LDH1对比具有统计学差异（均P < 0.05）。高水平的 NLR2、 NLR3、NLR4、PLR4、LDH1、LDH3、LDH4、ΔNLR1、ΔNLR2、ΔNLR3、ΔPLR1 的 OS 比低水平组均更短（均P < 0.05），高水平 的NLR2、NLR3、NLR4、PLR1、LDH1、ΔNLR1、ΔNLR2、ΔNLR3、ΔPLR1、ΔPLR2的PFS比低水平均更短（均P < 0.05）。NLR3-H 中PD-L1阴性患者占比最高，且阴性组、联合阳性分数（CPS） = 1~5、CPS ≥ 5 3组中的NLR3-H患者数量均比NLR3-L组多（均 P < 0.05）。NLR3-H、PLR3-H组中女性患者占比更高（均P < 0.05）。结论：NLR、PLR、LDH检测对MGC患者免疫治疗的疗效和 预后预测具有一定价值。

[Abstract] Objective: To explore the predictive value of combined evaluation of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lactate dehydrogenase (LDH) on the therapeutic effect and prognosis of ICIs (immune checkpoint inhibitors) in metastatic gastric cancer (MGC) patients. Methods: This study conducted a retrospective analysis of pre- and posttreatment peripheral hematological indicators of 88 MGC patients treated at Nanping First Hospital affiliated to Fujian Medical University. The recent treatment efficacy of the two patient groups was evaluated based on the solid tumor response evaluation criteria. χ2 tests were conducted to analyze and compare differences in disease control rate (DCR) and objective response rate (ORR), as well as differences in PD-L1 expression and clinical characteristics between the two groups. Survival analysis was performed using the Kaplan-Meier method for univariate analysis. Intergroup differences were detected by the Log-Rank test. Univariate analysis was conducted using the Cox proportional hazards regression model. Results: After immunotherapy, NLR3, NLR4, PLR2, PLR3, PLR4, LDH2 and LDH3 decreased significantly compared with those before treatment (all P < 0.05). There were significant statistical differences in NLR1 and LDH1 before treatment between the complete-remission (CR) + partial-remission (PR) group and the progressdisease (PD) group (all P < 0.05). Patients with higher levels of NLR2, NLR3, NLR4, PLR4, LDH1, LDH3, LDH4, ΔNLR1, ΔNLR2, ΔNLR3 and ΔPLR1 had shorter OS (all P < 0.05), and patients with higher levels of NLR2, NLR3, NLR4, PLR1, LDH1, ΔNLR1, ΔNLR2, ΔNLR3, ΔPLR1 and ΔPLR2 had shorter PFS compared with patients in low-level group (all P < 0.05). The percentage of PD-L1 negative patients among NLR3-H patients was the highest, and the number of NLR3-H patients in the NLR3-L group was larger than that in the negative group, the combined positive score (CPS) =1-5 group and the CPS ≥ 5 group (all P < 0.05). The proportion of women in the NLR3-H and PLR3-H groups was higher (all P < 0.05). Conclusion: The evaluation of NLR, PLR, and LDH has certain value in predicting the efficacy and prognosis of immunotherapy for MGC.