中性粒细胞与淋巴细胞比值对脊柱内镜术后疗效的预测价值

Study on the Predictive Value of Peripheral Blood Cells and the Ratio of Neutrophils to Lymphocytes after Spinal Endoscopy

目的:探讨外周血细胞及中性粒细胞与淋巴细胞比值对腰椎间盘突出症患者脊柱内镜术后疼痛缓解的预测价值。方法:通过回顾性研究方法,纳入2018年1月至2020年12月行脊柱内镜手术的腰椎间盘突出症患者150例,收集术前、术后外周血细胞(淋巴细胞、单核细胞、白细胞、中性粒细胞、嗜酸性粒细胞、嗜碱性粒细胞)和VAS评分,并计算中性粒细胞与淋巴细胞比值(NLR)。分析手术前后NLR和外周血细胞差异,采用Pearson相关性分析术前NLR与术前疼痛关系,Logistic回归分析影响腰椎间盘突出症患者术后疼痛缓解不良的危险因素,采用ROC曲线截取最佳诊断效能的NLR截点值;按截点值高低将腰椎间盘突出症患者分为高NLR组和低NLR组,比较两组术后疼痛的差异。结果:术后单核细胞、白细胞、中性粒细胞数均显著大于术前,术后淋巴细胞、嗜酸性粒细胞、嗜碱性粒细胞显著小于术前,差异均有统计学意义(P<0.05)。Pearson相关分析发现,NLR值与术前疼痛VAS评分正相关(R=0.719,P<0.05),NLR值越高,疼痛症状越明显。多元Logistic回归分析提示,NLR是腰椎间盘突出症患者行脊柱内镜术后疼痛缓解不良的独立因素。ROC工作曲线提示当NLR=1.708时预测效能最大(区域面积为0.726,显著性P<0.05)。组间比较提示低NLR组术后评分低于高NLR组。结论:腰椎间盘突出症患者行脊柱内镜术后,NLR可作为腰椎间盘突出症患者行脊柱内镜术后疼痛预测的重要评估值,尤其当NLR≥1.708时,应充分考虑其术后疼痛缓解不良的高风险性。

Objective:To investigate the predictive value of peripheral blood cells and the ratio of neutrophils to lymphocytes in pain relief after spinal endoscopy for lumbar disc herniation.Methods:150 patients with lumbar disc herniation underwent endoscopic spinal surgery from January 2018 to 2020 December were retrospective analyzed.Peripheral blood cells(lymphocytes,monocytes,leukocytes,neutrophils,eosinophils and basophils)and VAS scores were collected before and after surgery.The ratio of neutrophils and lymphocytes(NLR)was calculated.The difference between NLR and peripheral blood cells were analyzed before and after surgery.Pearson correlation analysis was used to analyze the relationship between preoperative NLR and preoperative pain.Logistic regression was used to analyze risk factors of poor postoperative pain relief in patients with lumbar disc herniation.ROC curve was used to intercept the NLR cutoff value for the best diagnostic performance.Patients with lumbar disc herniation were divided into high NLR and low NLR groups according to the cutoff value,and the difference in postoperative pain between the two groups were compared.Results:The numbers of monocytes,white blood cells and neutrophils after operation were significantly higher than those before operation(P<0.05),and the numbers of lymphocytes,eosinop-hils and basophils after operation were significantly lower than those before operation(P<0.05),there were statistical differences.Pearson correlation analysis found that the NLR value was positively correlated with preoperative pain VAS(R=0.719,P<0.05).The higher NLR value showed more obvious the pain symptoms.Multivariate logistic regression analysis showed that NLR was an independent factor for poor pain relief after spinal endoscopy in patients with lumbar disc herniation.The ROC working curve indicated that the prediction power was the largest when NLR=1.708(regional area was 0.726,significance P<0.05).The comparison between groups showed that the postoperative score of the low NLR group was lower than that of the high NLR group.Conclusion:NLR can be used as an important evaluation value for the prediction of postoperative pain in patients with lumbar disc herniation after endoscopic spinal surgery,especially when NLR≥1.708,the high risk of poor postoperative pain relief should be fully considered.