术前血小板/淋巴细胞比值与胰十二指肠切除术后静脉血栓栓塞症的发生及预后的关系

Relationship between platelet/lymphocyte ratio and venous thromboembolism incidence and prognosis after pancreaticoduodenectomy

目的探讨术前血小板/淋巴细胞比值(PLR)与胰十二指肠切除(PD)术后静脉血栓栓塞症(VTE)的发生及预后的关系。方法回顾性分析2014年1月至2018年12月在新疆医科大学附属第一、第五医院行PD术的206例患者资料,比较VTE组及非VTE组患者在术前资料、手术因素、血常规、PLR方面的差异,绘制术前PLR预测术后VTE的受试者工作特征(ROC)曲线。根据PLR临界值进一步将VTE组分为高PLR亚组和低PLR亚组,分析两亚组在VTE血栓形成部位、术后生存时间方面有无差异。结果PD术后发生VTE组(63例)和非VTE组(143例)在PLR上具有统计学差异(t=5.324,P<0.001)。PLR预测术后VTE的ROC曲线下面积(AUC)为0.853(95%CI 0.784~0.928),敏感性为90.3%,特异性为75.0%,PLR临界值为244.54。高PLR亚组(n=30)术后双侧静脉血栓(BVT)12例、肺栓塞(PTE)13例,低PLR亚组(n=33)BVT 5例、PTE 6例,两亚组存在统计学差异(BVT:χ^(2)=4.925,P=0.026;PTE:χ^(2)=4.720,P=0.030)。高PLR亚组术后中位生存时间11个月(95%CI 10.238~11.762),低PLR亚组为12个月(95%CI 10.530~13.470),差异有统计学意义(χ^(2)=5.909,P=0.015)。结论术前PLR是PD术后发生VTE的独立危险因素,PLR值越大,术后发生静脉栓塞的风险越高,患者术后生存时间越短。根据术前PLR值早期干预具有VTE高风险的患者,可以延长患者PD术后生存时间。

Objective To investigate the relationship between preoperative platelet/lymphocyte ratio(PLR)and the venous thromboembolism(VTE)and prognosis after pancreaticoduodenectomy(PD).Methods The clinical data of 206 patients undergoing PD in the First and Fifth Affiliated Hospitals of Xinjiang Medical University from Jan.2014 to Dec.2018 were retrospectively analyzed,and the differences in preoperative data,surgical factors,routine blood test and PLR between the postoperative VTE group and the non-VTE group were compared.The receiver operating characteristic(ROC)curve for preoperative PLR prediction for VTE after PD was plotted.According to the PLR critical value,the VTE group was further divided into high PLR subgroup and low PLR subgroup,and the differences in thrombosis site and postoperative survival time between the two subgroups were analyzed.Results Postoperative VTE group(63 patients)and non-VTE group(143 patients)had statistically significant difference in preoperative PLR(t=5.324,P<0.001).The area under ROC curve(AUC)of VTE predicted by PLR was 0.853(95%CI 0.784-0.928),the sensitivity was 90.3%,the specificity was 75.0%,and the boundary value of PLR was 244.54.In the high PLR subgroup(n=30),bilateral venous thrombosis(BVT)was found in 12 cases and pulmonary thromboembolism(PTE)in 13 cases;in the low PLR subgroup(n=33),BVT was found in 5 cases and PTE in 6 cases,the differences between two groups were significant(DVT:χ^(2)=4.925,P=0.026;PTE:χ^(2)=4.720,P=0.030).The median postoperative survival time of patients in high PLR subgroup was 11 months(95%CI 10.238-11.762),and 12 months(95%CI 10.530-13.470)in PLR subgroup(χ^(2)=5.909,P=0.015).Conclusion Preoperative PLR is an independent risk factor for the occurrence of VTE after PD.The higher PLR predicts the higher risk of postoperative VTE and the shorter postoperative survival time for patients ofter PD.