淋巴细胞相关炎症评分在预测老年髋部骨折术后认知功能障碍风险的临床研究

Clinical study of the lymphocyte-associated inflammation score in predicting the risk of postoperative cognitive dysfunction after hip fracture in the elderly

目的 基于中性粒细胞-淋巴细胞比率 (neutrophil to lymphocyte ratio,NLR)、血小板-淋巴细胞比率 (platelet-lymphocyte ratio,PLR) 和单核细胞-淋巴细胞比率 (monocyte-lymphocyte ratio,MLR) 构建淋巴细胞相关炎症评分 (lymphocyte-associated inflammation score,LAIS),评估老年髋部骨折患者术后认知功能障碍(postoperative cognitive dysfunction,POCD) 风险。方法 回顾分析 2020 年 6 月 1 日至 2023 年 6 月 30 日在我院治疗的 181 例老年髋部骨折患者,术前收集患者 NLR、PLR 和 MLR,基于 ROC 曲线构建 LAIS。采用多因素 Logistic 回归模型分析老年髋部骨折患者危险因素并采用 ROC 曲线进行性能评估。结果 181 例老年髋部骨折患者中,POCD 发生率为 21.5% (39 / 181)。POCD 患者 NLR、PLR 和 MLR 均高于无 POCD 患者 (P < 0.05);ROC 曲线分析结果显示,NLR、PLR 和 MLR 的 AUC 分别为 0.765 (0.696~0.825)、0.761 (0.692~0.821) 及 0.773 (0.705~0.832),最佳截断值分别为 > 2.62、> 168.62 及 > 0.47。多因素 Logistic 回归分析结果显示:年龄 (OR:2.100,95% CI:1.141~1.268),糖尿病 (OR:2.125,95% CI:1.055~4.412),ASA 评分 (3 分)(OR:2.230,95% CI:1.071~4.231),TNF-α (OR:2.227,95% CI:1.005~3.552) 和 LAIS (OR:2.954,95% CI:1.567~4.652) 为老年髋部骨折患者 POCD 独立危险因素 (P < 0.05)。ROC 曲线分析结果显示,年龄、糖尿病、ASA 评分、TNF-α 和 LAIS 的 AUC 分别为 0.604 (0.529~0.676)、0.639 (0.565~0.709)、0.619(0.544~0.690)、0.782 (0.714~0.840) 及 0.847 (0.786~0.896)。结论 老年髋部骨折 POCD 发生率较高,LAIS 能够在术前提供可靠的 POCD 风险评估,指导和完善围术期患者诊疗方案,降低 POCD 风险。

Objective To assess the risk of postoperative cognitive dysfunction (POCD) in elderly hip fracture patients by constructing the Lymphocyte-Associated Inflammation Score (LAIS) based on Neutrophil to lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR),and monocyte-lymphocyte ratio (MLR).Methods In a retrospective analysis of 181 elderly hip fracture patients treated in our hospital from June 1,2020,to June 30,2023,NLR,PLR and MLR of patients were collected preoperatively,and LAIS was constructed based on the joint receiver operating characteristic (ROC) curve.A multivariate logistic regression model was used to analyze the risk factors of elderly hip fracture patients,and the ROC curve was used for performance assessment.Results Among 181 elderly hip fracture patients,the incidence of POCD was 21.5% (39 / 181).The NLR,PLR and MLR were higher in patients with POCD than in those without POCD (P < 0.05).The results of ROC curve analysis showed that the AUC of NLR,PLR and MLR were 0.765 (0.696-0.825),0.761 (0.692-0.821) and 0.773 (0.705-0.832),with optimal cut-off values of > 2.62,> 168.62 and > 0.47,respectively.The results of multifactorial logistic regression analysis showed that age (OR:2.100,95% CI:1.141-1.268),diabetes mellitus (OR:2.125,95% CI:1.055-4.412),ASA score (3) (OR:2.230,95% CI:1.071-4.231),TNF-α (OR:2.227,95% CI:1.005-3.552),and LAIS (OR:2.954,95% CI:1.567-4.652) were the POCD in elderly patients with hip fracture independent risk factors (P < 0.05).The results of ROC curve analysis showed that the AUCs for age,diabetes mellitus,ASA score,TNF-α and LAIS were0.604 (0.529-0.676),0.639 (0.565-0.709),0.619 (0.544-0.690),0.782 (0.714-0.840) and 0.847 (0.786-0.896).Conclusions The incidence of POCD in elderly hip fractures is high.LAIS could provide a reliable preoperative assessment for the risk of POCD,improving the perioperative diagnosis and treatment plan and reducing the riskof POCD.