1.Department of Laparoscopic Surgery,Affiliated Wuxi People'2.'3.s Hospital of Nanjing Medical University
目的 本研究旨在评估胆囊切除术前血小板-淋巴细胞比值(PLR)和中性粒细胞-淋巴细胞比率(NLR)是否可以区分单纯性和重度胆囊炎。方法 该项单中心回顾性研究评估了2009年1月至2019年1月因胆囊炎在无锡市人民医院腔镜外科行胆囊切除术的280名患者的病例资料。重度胆囊炎定义为胆囊炎合并继发性改变,包括出血,坏疽,化脓和穿孔。PLR和NLR分别根据患者入院时血小板计数与绝对淋巴细胞计数的比值、绝对中性粒细胞计数与绝对淋巴细胞计数的比值进行计算。采用受试者特征曲线(ROC曲线)分析来确定PLR、NLR与胆囊炎严重程度相关的最佳值,并根据PLR和NLR临界值对临床表现的差异进行分析。结果 所有患者包括单纯性胆囊炎212人(75.7%)和重度胆囊炎68人(24.3%)。PLR为129.0可预测重度胆囊炎,敏感性为86.8%,特异性为60.4%。PLR≥129组包括较多重度胆囊炎(P<0.001)、白细胞计数较高(P<0.001)及首诊为急诊的患者(P<0.001)。NLR为3.0可预测重度胆囊炎,敏感性为82.4%,特异性为84.4%。NLR数值增高(≥3.0)与高龄(P = 0.039)、男性(P = 0.010)、重度胆囊炎(P<0.001)、白细胞计数较高(P<0.001)、经急诊收入院(P<0.001)及住院时间延长(P<0.001)有显著相关性。多变量分析发现患者年龄≥55岁(OR 2.808,95%CI 1.375-5.735,P = 0.005),术前白细胞计数术≥10000(OR 3.004,95%CI 1.130-7.981,P = 0.027),术前NLR≥3.0(OR 9.564,95%CI 4.194-21.812,P<0.001)和经急诊入院(OR 2.657,95%CI 1.166-6.054,P = 0.020)是与住院时间延长相关的独立危险因素。结论 术前PLR和NLR可作为重度胆囊炎的预测指标,可为是否选择手术提供参考。
Objective To investigate preoperative PLR and NLR in patients with cholecystitis and to identify a relevant NLR value that discriminates between simple and severe cholecystitis. Methods This study included 280 patients who under went laparoscopic cholecystectomy due to cholecystitis. The Receiver Operating Characteristic (ROC) analysis was performed to identify the most useful PLR cut-off value and NLR cut-off value in relation to the severity of cholecystitis. The patients were divided into two groups according to the cut-off NLR and PLR value. Severe cholecystitis was defined when the cholecystitis was complicated by secondary changes, including hemorrhage, gangrene, emphysema, and perforation. The NLR was calculated at admission as the absolute neutrophil count divided by the absolute lymphocyte count. Results Our study population comprised 212 patients with simple cholecystitis (75.7%) and 68 patients with severe cholecystitis (24.3%). The PLR of 129.0 could predict severe cholecystitis with 86.8% sensitivity and 60.4% specificity. The NLR of 3.0 could predict severe cholecystitis with 82.4% sensitivity and 84.4% specificity. A higher PLR (129) group was significantly associated with severe cholecystitis (P<0.001), higher white blood cell count (P<0.001) and admission via the emergency department (P<0.001). A higher NLR (3.0) was significantly associated with older age (P = 0.039), male gender (P = 0.010), severe cholecystitis (P<0.001), higher white blood cell count (P<0.001), admission via the emergency department (P<0.001) and prolonged length of hospital stay (LOS, P<0.001). Multivariate analysis found that patient age 55 years (OR 2.808,95%CI 1.375-5.735,P = 0.005), white blood cell count 10000 (OR 3.004,95%CI 1.130-7.981,P = 0.027), preoperative NLR 3.0 (OR 9.564,95%CI 4.194-21.812,P<0.001), and admission via the emergency department (OR 2.657,95%CI 1.166-6.054,P = 0.020) were independent factors associated with prolonged LOS. Conclusions PLR 129.0 and NLR 3.0 were significantly associated with severe cholecystitis and prolonged LOS in patients undergoing cholecystectomy. Therefore, preoperative PLR and NLR in patients undergoing cholecystits due to cholecystitis seemed to be a useful surrogate marker for severe cholecystitis.