Ratio of mean platelet volume to platelet count is a potential surrogate marker predicting liver cirrhosis

AIM To provide a simple surrogate marker predictive of liver cirrhosis(LC).METHODS Specimens from 302 patients who underwent resection for hepatocellular carcinoma between January 2006 and December 2012 were retrospectively analyzed. Based on pathologic findings, patients were divided into groups based on whether or not they had LC. Parameters associated with hepatic functional reserve were compared in these two groups using MannWhitney U-test for univariate analysis. Factors differing significantly in univariate analyses were entered into multivariate logistic regression analysis.RESULTS There were significant differences between the LC group(n = 100) and non-LC group(n = 202) in prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, cholinesterase, type Ⅳ collagen, hyaluronic acid, indocyanine green retention rate at 15 min, maximal removal rate of technitium-99 m diethylene triamine pentaacetic acid-galactosyl human serum albumin and ratio of mean platelet volume to platelet count(MPV/PLT). Multivariate analysis showed that prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin and hyaluronic acid, and MPV/PLT ratio were factors independently predictive of LC. The area under the curve value for MPV/PLT was 0.78,with a 0.8 cutoff value having a sensitivity of 65% and a specificity of 78%.CONCLUSION The MPV/PLT ratio, which can be determined simply from the complete blood count, may be a simple surrogate marker predicting LC.

Usefulness of white blood cell count to mean platelet volume ratio for predicting long-term prognosis after primary percutaneous coronary intervention in patients with acute coronary syndrome

Background and Objective The white blood cell count to mean platelet volume ratio(WMR)has recently been described as a predictor of cardiovascular events in patients who undergo percutaneous coronary intervention(PCI).The aim of this study was to investigate the usefulness of admission WMR in predicting outcomes in patients with acute coronary syndrome(ACS).

Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis

AIM: To validate whether the platelet count/spleen size ratio can be used to predict the presence of esophageal varices in Mexican patients with hepatic cirrhosis.

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

BACKGROUND Platelet count or complete blood count(CBC)-based ratios including lymphocyteto-monocyte(LMR),neutrophil-to-lymphocyte(NLR),hemoglobin-to-platelet(HPR),red blood cell count distribution width-to-platelet(RPR),and platelet-tolymphocyte(PLR)ratio are good predictors of colorectal cancer(CRC)survival.Their change in time is not well documented,however.AIM To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties,comorbidities,and anamnestic data.METHODS A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients,who attended at Semmelweis University,Budapest.CBC ratios and two additional newly defined personalized platelet count metrics(pPLT_(D)and pPLT_(S),the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery,respectively)were recorded.RESULTS The 835 CRC patients had a total of 4608 measurements(5.52 visits/patient,in average).Longitudinal survival models revealed that the increases/decreases in LMR[hazard ratio(HR):0.4989,P<0.0001],NLR(HR:1.0819,P<0.0001),HPR(HR:0.0533,P=0.0038),pPLT_(D)(HR:4.9229,P<0.0001),and pPLT_(S)(HR:4.7568,P<0.0001)values were poor prognostic signs of disease-specific survival.The same was obtained for all-cause mortality.Most abnormal changes occurred within the first 3 years after the diagnosis of CRC.RPR and PLR had an only marginal effect on diseasespecific(P=0.0675)and all-cause mortality(Bayesian 95%credible interval:0.90–186.05),respectively.CONCLUSION LMR,NLR,and HPR are good metrics to follow the prognosis of the disease.pPLT_(D)and pPLT_(S)perform just as well as the former,while the use of RPR and PLR with the course of the disease is not recommended.Early detection of the abnormal changes in pPLT_(D),pPLT_(S),LMR,NLR,or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.

Mean Platelet Volume as an Inflammation Marker, Possible Biomarker of Tumor Detection in Prostate Biopsy

Background: In the diagnosis of prostatic diseases, the need for markers other than prostate specific antigen (PSA) has been increasing in recent years. So, we aimed to determine the predictive value, the neutrophil lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume before prostate biopsy in predicting the results of pathology. Transrectal ultrasound-guided biopsy of the prostate was performed because of high PSA values and compared values of these parameters to predict of pathology results. Methods: 2715 patients who underwent 10 - 12 quadrant transrectal ultrasound-guided prostate biopsies between January 2008 and January 2018 have been evaluated retrospectively. Patients were divided into groups according to the biopsy pathology results by benign (group 1), atypical small acinar proliferation (ASAP) (group 2) and prostate cancer (group 3). A total of 204 patients who were benign prostate hyperplasia in 71 patients (34.8%), atypical small acinar proliferation in 80 (39.21%) and prostate adenocarcinoma (PCa) in 53 patients (25.98%) were included in the study by systematic sampling. Before the biopsy total PSA (tPSA), free PSA (fPSA), rate of percentage of free to total prostate specific antigen (f/tPSA) rate, PSA density (PSA-D), white blood cell (WBC) count, blood neutrophil count (NC), blood lymphocyte count (LC), neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) were measured and compared in all groups. Differences in continuous variables were assessed using the ANOVA. Logistic regression was used to analyze the linear relationship between predictive variables and pathology results. P < 0.05 was considered statistically significant. Results: NLR and PLR values were lower in group 1 than group 2 and were found statistically significant between in group 1 and group 2 (p: 0.03 and p: 0.02, respectively). MPV value was found 1.7 times higher in patients who were diagnosed with ASAP pathology than those with benign pathologies. Although there was statistically significant increase in MPV values in logistic regression results, no statistically significant diagnostic value was found. In addition MPV value was found 0.5 times higher in patients who were diagnosed patients with ASAP than prostate cancer group. ROC analysis showed that the optimal threshold was 7.65 femtoliter (sensitivity: 51%;specificity: 30%) and was found to be a statistically significant diagnostic value to distinguish groups 2 and 3. The lowest value of MPV was found in group 3. Conclusions: In cases where the PSA value is insufficient in predicting the pathology result, the effect of NLR, PLR and MPV on differential diagnosis can be kept in mind. While NLR and PLR are more useful in the diagnosis of ASAP, MPV is more effective in the diagnosis of malignancy.

New indicators in evaluation of hemolysis,elevated liver enzymes,and low platelet syndrome:A case-control study

BACKGROUND Indices such as the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),and red cell distribution width(RDW)are considered new markers of the systemic inflammatory response(SIR),and have been widely implemented for the diagnosis of patients with inflammatory diseases.These new indicators have also been widely investigated in preeclampsia(PE)but less analyzed in hemolysis,elevated liver enzymes,and low platelet(HELLP)syndrome.AIM To compare SIR markers among HELLP patients,PE only patients,and healthy gravidae.METHODS This retrospective case-control study enrolled 630 cases,including 210 patients with HELLP syndrome(HELLP group),210 patients with only PE(PE group)and 210 healthy gravidae(control group).The three groups were matched by age,parity,status of assisted reproduction,and multiple pregnancies.Birthweight,gestational age at complete blood count collection,gestational age at delivery,mode of delivery,etc.were recorded.The main indices as NLR,PLR,MPV,PDW,and RDW among the groups were compared,as well as some secondary outcomes including neutrophil,platelets,and hemoglobin.RESULTS The NLR(6.4 vs 4.3 vs 3.5),MPV(11.9 vs 11.2 vs 10.7),PDW(16.4 vs 13.3 vs 14.2),leukocyte(12.4×10^(9)/L vs 9.7×10^(9)/L vs 8.7×10^(9)/L)and neutrophil count(9.9×10^(9)/L vs 7.3×10^(9)/L vs 6.1×10^(9)/L)were highest in the HELLP group,lower in the PE group,and lowest in the control group.Both the overall comparisons between the three groups(all bP<0.01)and pairwise comparisons between every two groups elicited statistically significant differences(all dP<0.01,except control vs PE:cP<0.05 in PDW).The average lymphocyte counts were 1.4(1.1,2.0)×10^(9)/L in the HELLP group,1.6(1.3,2.0)×10^(9)/L in the PE group and 1.7(1.4,2.0)×10^(9)/L in the control group.The overall comparison of lymphocyte count within the three groups had statistically significant differences(P=0.000).The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE(P=0.019)and control groups(P=0.000),but the difference between the PE and control groups was not statistically significant(P=0.432).The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences(both P=0.000),from low to high being those in the HELLP group(43.4×10^(9)/L,64.0),control group(180.5×10^(9)/L,103.6)and PE group(181.5×10^(9)/L,112.8).Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups(both P>0.05),while the differences in the two indices between the HELLP group and the two other groups were still statistically significant(all P=0.000).RDW values were highest in the HELLP group(14.5%[13.6,15.3]),lower in the control group(14.1%[13.5,14.8])and lowest in the PE group(13.9%[13.4,14.9]).The difference between the PE and control group did not show statistical significance(P=1.000),while RDW values in the HELLP group were higher than those in the other two groups(cP<0.05 vs control,dP<0.01 vs PE).CONCLUSION SIR markers such as NLR,RDW,MPV,and PDW were increased and PLR was decreased in HELLP.These SIR markers may become new indicators in the evaluation of HELLP syndrome.

Tumor-infiltrating platelets predict postoperative recurrence and survival in resectable pancreatic neuroendocrine tumor

BACKGROUND Platelets have been reported to participate in tumor cell growth,extravasation,epithelial–mesenchymal transition,metastasis,and drug resistance.However,the importance of platelets in pancreatic neuroendocrine tumor(pNET)lacks adequate literature support.The predictive value of tumor-infiltrating platelets(TIPs)in pNET remains unclear.AIM To investigate the relationship between TIPs and the prognosis of patients with pNET following radical resection.METHODS In total,113 patients who had undergone radical surgical resection with a pathologic diagnosis of pNET were enrolled in this study.Immunohistochemical analysis of cluster of differentiation 42b(CD42b)expression in the tumor specimens was performed to determine the presence of TIPs.Univariate and multivariate analyses were used to analyze the prognostic value of TIPs.RESULTS TIPs were observed in intratumoral areas in 54 patients.Neither basic characteristics nor preoperative platelet-associated indicators showed a significant relationship with the presence of TIPs(all P>0.05).Patients with positive intratumoral CD42b expression had worse overall survival(P=0.005)and recurrence-free survival(P<0.001)than those with negative intratumoral CD42b expression.Multivariate analysis demonstrated that TIPs were independent prognostic factors for overall survival(P=0.049)and recurrencefree survival(P=0.003).Nevertheless,platelet count,mean platelet volume,and platelet-to-lymphocyte ratio were not associated with postoperative survival or recurrence in pNET patients(all P>0.05).CONCLUSION TIPs are a useful prognostic biomarker for patients with resectable pNET,and their detection represents a promising tool for pNET treatment strategy decisions.

Role of platelet parameters as a biomarker in diagnosis of acute appendicitis: A retrospective case-controlled study

Objective: To investigate the diagnostic value of platelet parameters in acute appendicitis. Methods: This retrospective case-controlled study was performed among 200 healthy people and 200 patients with a primary diagnosis of acute appendicitis between October 2017 and June 2018. The patients were classified into three groups: the acute complicated appendicitis (suppurative and gangrenous) group, acute non-complicated appendicitis group and the control group. Red blood cell, white blood cell, lymphocyte, monocyte and platelets count, red blood cell distribution width, hemoglobin, hematocrit, mean platelet volume, platelet distribution width, and C-reactive protein were compared between the groups. Results: Thirty-nine (19.5%) patients with acute appendicitis had no complication and 161 (80.5%) developed a complication. The white blood cell count, neutrophil count and C-reactive protein serum levels were significantly higher, whereas the mean age, lymphocyte count, monocyte count, red blood cell distribution width and platelet count were significantly lower in acute appendicitis patients with and without complications compared with the control group. Moreover, combined analysis of best diagnostic parameters (white blood cell, neutrophil and lymphocyte counts) showed that combined parallel sensitivity and specificity were 98.7% and 42.7%, respectively. Conclusions: White blood cell, lymphocyte counts and neutrophil count could be used for diagnosis of acute appendicitis. More over the utility of mean platelet volume for differential diagnosis might be overestimated.

Changes in Platelet Indices during Pregnancy as Potential Markers for Prediction of Preeclampsia Development

Objective: To assess whether changes in platelet indices, detectable by simple complete blood count (CBC), during pregnancy could be used as markers for prediction of development of preeclampsia (PE). Methods: A total of 2813 pregnant women who received regular antenatal care until delivery were included. Participants were divided into 3 groups: normotensive pregnant women (n = 2621), women with PE without severe features (n = 169), and women with PE with severe features (n = 23). Blood samples were collected during antenatal visits and/or during the period of in-patient hospital stay, and changes in platelet indices were compared among the three groups. Results: Platelet count (PC) was decreasing while mean platelet volume (MPV) and platelet distribution width (PDW) were increasing as PE progressed. Receiver operating characteristics (ROC) curve analysis showed that PDW had the largest area under curve (AUC) [0.980 (95% CI: 0.964 - 1.000)], making it the best marker for predicting development of PE. Also, PDW showed the most statistically significant correlation with mean arterial pressure (MAP) (r = 0.902, p = 0.000), making it the best marker for predicting severity of hypertension. Conclusion: This study provides evidence that PC decreases while MPV and PDW increase as pregnancy advances, and these changes are more pronounced in PE than normotensive pregnancy. These changes predate development of PE by 2 - 8 weeks and are proportional to the progress of this disorder. The selected platelet indices, especially PDW, have the potential to be utilized as markers for not only prediction of PE development but also severity of hypertension.

Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients

BACKGROUND Colorectal cancer is the third most common malignancy worldwide.Therefore,it is critically important to identify new useful markers that can be easily obtained in routine practice.Inflammation is a crucial issue in the pathogenesis and development of cancer.AIM To evaluate the prognostic value of absolute monocyte count,monocyte to lymphocyte ratio(MLR),the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio(NLR-PLR),and combined platelet and neutrophilto-lymphocyte ratio(PLT-NLR)in peripheral blood samples of patients with colorectal cancer undergoing surgery.METHODS We conducted a retrospective study of 160 patients with colorectal cancer who underwent surgery,and 42 healthy controls.The status of absolute monocyte count,MLR,NLR-PLR and PLT-NLR was calculated on the basis of blood samples obtained before and after surgery.Haematologic factors were examined in correlation with the type of tumour growth,tumour size,histological type,percentage of mucinous component,grade of malignancy,Tumour-Node-Metastasis stage,venous,lymphatic and perineural invasion of cancer cells,status of lymph node invasion and the presence of cancer cell deposits.The Kaplan-Meier method and the long-rank test were used to compare survival curves.To determine independent prognostic factors,univariate and multivariate Cox proportional hazards regression models were applied.RESULTS The PLT-NLR status was correlated with tumour size and the presence of perineural invasion(P=0.015;P=-0.174,P=0.037).Moreover,high NLR-PLR and PLR-NLR ratios in the blood samples obtained after surgery were positively associated with histological type of cancer and percentage of the mucinous component(NLR-PLR:P=0.002;P=0.009;PLR-NLR status:P=0.002;P=0.007).The analysis of 5-year disease-free survival showed that the MLR of whole blood obtained after surgery[HR=2.903,95%CI:(1.368-6.158),P=0.005]and the status of lymph node metastasis[HR=0.813,95%CI:(0.653-1.013),P=0.050]were independent prognostic factors in colorectal cancer patients.CONCLUSION The postoperative MLR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer.

凝血功能联合平均血小板体积与血小板计数比值对脑梗死的诊断价值

目的探讨凝血功能指标联合平均血小板体积与血小板计数比值对急性脑梗死(ACI)的诊断价值。方法95例ACI患者按照疾病严重程度分为轻度39例、中度37例及重度19例,比较不同程度ACI患者入院时的凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D二聚体(D-Dimer)、纤维蛋白溶解产物(FDP)]和平均血小板体积与血小板计数比值;采用ROC曲线下面积(AUC)评估凝血功能指标、平均血小板体积与血小板计数比值单项或联合检测对ACI严重程度的诊断价值;采用Pearson相关系数(r)分析各项检测指标与ACI的相关性。结果轻度组患者PT、APTT及TT长于中度组和重度组,FIB、D-Dimer、FDP及平均血小板体积与血小板计数比值低于中度组和重度组,差异有统计学意义(P<0.05);ROC曲线结果显示,凝血功能指标、平均血小板体积与血小板计数比值联合检测诊断ACI的AUC为0.943,高于其他单项检测的AUC;相关性分析显示,ACI患者PT、APTT、FIB、TT、D-Dimer、FDP及平均血小板体积与血小板计数比值均存在一定的相关性(P<0.05)。结论不同严重程度ACI患者的凝血功能指标及平均血小板体积与血小板计数比值存在明显差异,凝血功能指标及平均血小板体积与血小板计数比值对ACI诊断具有一定价值,联合检测诊断价值更高。

急性冠状动脉综合征患者入院早期白细胞计数与平均血小板体积比值和血小板与淋巴细胞比值与冠状动脉狭窄程度及院内主要不良心血管事件的评估价值

目的 分析急性冠状动脉综合征(ACS)患者的白细胞计数与平均血小板体积比值(WMR)和血小板与淋巴细胞比值(PLR)与冠状动脉病变严重程度的相关性,并探究WMR、PLR对冠状动脉狭窄程度及院内主要不良心血管事件(MACE)的预测价值。方法 本研究为回顾性分析,收集了2020年12月至2022年11月在新疆医科大学第一附属医院急诊抢救室因胸痛、胸闷首次诊断为ACS并接受经皮冠状动脉介入(PCI)治疗的391例患者数据。根据临床分型,将患者分为不稳定型心绞痛(UA)组147例,非ST段抬高型心肌梗死(NSTEMI)组114例,及ST段抬高型心肌梗死(STEMI)组130例。进一步按照是否出现院内MACE分为MACE组106例和无MACE组285例。依据Gensini评分中位数将患者分为重度病变组(Gensini评分≥53分)196例和轻度病变组(Gensini评分<53分)195例。比较各组患者的基本资料及实验室检查指标,使用二元多因素logistic回归模型筛选冠状动脉狭窄程度及院内MACE的影响因素,分析WMR、PLR与冠状动脉狭窄程度的相关性,并通过ROC曲线分析WMR、PLR及其联合对冠状动脉狭窄程度及院内MACE的预测诊断价值。结果 WMR和PLR与ACS患者冠状动脉狭窄程度均呈正相关(r=0.336,P<0.001;r=0.374,P<0.001)。二元多因素logistic回归分析表明,WMR和PLR均为冠状动脉狭窄程度和院内MACE的独立危险因素。ROC曲线结果显示,WMR、PLR及两者联合预测院内MACE的AUC分别为0.748、0.722和0.792;预测冠状动脉狭窄程度的AUC分别为0.694、0.716和0.770。结论 ACS患者入院早期WMR和PLR与冠状动脉狭窄程度呈正相关,并且具有预测院内MACE及冠状动脉狭窄程度的临床价值,其联合使用在诊断效果上更为优越。

MPVLR与消化性溃疡并发上消化道出血的关系

目的探讨平均血小板体积/淋巴细胞比值(MPVLR)与消化性溃疡(PU)并发上消化道出血(UGIB)的关系及其意义。方法将2021年6月—2023年6月安阳市人民医院诊治的233例PU病人作为研究组,另取同期体检健康人群210例为对照组。受试者入院后24 h内检测平均血小板体积(MPV)、淋巴细胞计数(LYM),并计算MPVLR。根据PU病人随访期间是否并发UGIB分为UGIB组(72例)及非UGIB组(161例)。采用受试者工作特性(ROC)曲线评估MPVLR对PU并发UGIB的诊断价值,采用多因素Logistic回归分析影响PU并发UGIB的危险因素。结果研究组MPVLR明显高于对照组(t=70.287,P<0.05)。UGIB组MPVLR明显高于非UGIB组(t=26.566,P<0.05)。ROC曲线分析显示,MPVLR诊断PU病人并发UGIB的曲线下面积为0.741(95%CI=0.761~0.861)。多因素Logistic逐步回归分析显示,使用非甾体类抗炎药物(OR=2.423,95%CI=1.650~3.558)、幽门螺杆菌感染(OR=3.047,95%CI=1.802~5.151)以及MPVLR(OR=3.762,95%CI=2.001~7.072)均为影响PU并发UGIB的危险因素(P<0.05)。结论MPVLR在PU并发UGIB病人中异常升高,对UGIB发生具有较高的预测价值。

抗栓治疗后血小板参数对非心源性脑梗死预后的预测价值研究

目的研究抗栓治疗后血小板参数对非心源性脑梗死(NCCI)预后的预测价值。方法71例NCCI患者,所有患者均于入院首日抗栓之前完成血小板参数[血小板分布宽度(PDW)、平均血小板体积(MPV)、血小板计数(PLT)、PDW/PLT、MPV/PLT]测定。抗栓7 d后,所有NCCI患者均完善PDW、MPV、PLT、PDW/PLT、MPV/PLT复查,分别以PLT7、PDW7、MPV7、MPV7/PLT7、PDW7/PLT7表示。选取改良Rankin量表(MRS)对患者6个月时神经功能恢复情况做出评估,根据预后评估结果分为预后不良组(MRS评分>2分,10例)与预后良好组(MRS评分≤2分,61例)。①比较两组一般资料及血化验结果;②采用多因素Logistic回归分析NCCI患者抗栓7 d后预后不良的危险因素;③采用受试者工作特征曲线(ROC曲线)分析阳性指标对NCCI患者预后的预测价值。结果抗栓后,61例患者预后良好,10例患者预后不良。两组患者年龄、性别、饮酒、吸烟、冠心病、糖尿病、高血压、白细胞计数、尿酸、尿素氮、肌酐、同型半胱氨酸、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、总胆固醇、MPV、PDW、PLT7、PDW/PLT水平比较差异无显著性(P>0.05)。预后不良组患者PLT(157.72±46.53)×10^(9)/L明显低于预后良好组的(195.04±55.42)×10^(9)/L,MPV/PLT(0.77±0.14)×10^(-10)fl/L明显高于预后良好组的(0.61±0.23)×10^(-10)fl/L,差异有显著性(P<0.05);预后不良组患者MPV7、MPV7/PLT7、PDW7、PDW7/PLT7分别为(14.72±4.07)fl、(0.73±0.23)×10^(-10)fl/L、(11.63±1.48)fl、(0.92±0.39)×10^(-10)fl/L,明显高于预后良好组的(12.29±3.26)fl、(0.52±0.21)×10^(-10)fl/L、(9.81±1.58)fl、(0.71±0.25)×10^(-10)fl/L,差异有显著性(P<0.05)。将单因素分析中显示差异有显著性的因素(PLT、MPV/PLT、PDW7、PDW7/PLT7、MPV7、MPV7/PLT7)纳入多因素Logistic回归分析,结果显示:MPV7为NCCI患者预后不良的危险因素[OR=7.668,95%CI=(1.526,38.527),P=0.012<0.05]。ROC曲线显示:MPV7对NCCI患者的预后具有预测价值,以10.13 fl为临界值,MPV7预测NCCI患者预后不良的曲线下面积(AUC)为0.786[95%CI=(0.677,0.896),P=0.001<0.05],灵敏度为83.33%,特异度为69.50%。结论抗栓7 d后MPV为NCCI患者预后不良的危险因素,可辅助预测NCCI预后情况。

NLR、PLR、MPVLR、PDWLR对系统性红斑狼疮和狼疮性肾炎临床预测作用的研究进展

系统性红斑狼疮(SLE)是一种可导致多种器官受累的自身免疫性疾病,其特征是持续的慢性炎症反应,狼疮性肾炎(LN)是SLE最严重的并发症之一,也是导致患者死亡的重要原因。中性粒细胞与淋巴细胞比值(NLR)、血小板计数与淋巴细胞比值(PLR)、平均血小板体积与淋巴细胞比值(MPVLR)、血小板体积分布宽度与淋巴细胞比值(PDWLR)作为常见的外周血细胞参数,是一种新兴的系统性炎症标志物,反映了机体在炎症反应与免疫失衡中的内环境变化。该综述重点介绍了NLR、PLR、MPVLR、PDWLR对SLE和LN的预测作用,总结对比了NLR与PLR、MPVLR与PDWLR对SLE预测的灵敏度,为评估SLE疾病活动度和LN肾脏受累程度提供参考价值。目前对于这些炎症标志物的研究仍处于早期研究阶段,仍缺少各炎症标志物之间联合应用的研究以及多中心、大样本、前瞻性研究进行验证。

中性粒细胞与淋巴细胞比值、淋巴细胞与单核细胞比值、血小板与淋巴细胞比值及平均血小板体积在骨髓增殖性肿瘤血栓形成中的临床意义

目的探讨中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)及平均血小板体积(MPV)在骨髓增殖性肿瘤(MPN)血栓形成中的意义。方法根据确诊MPN至随访截止时间内发生血栓事件将225例MPN患者分为血栓组(36例)及无血栓组(189例),收集初诊时的基线资料并进行组间比较,采用单因素及多因素logistic回归分析探讨MPN患者发生血栓事件的危险因素。采用受试者工作特征(ROC)曲线得出相关指标对MPN血栓形成的最佳截断值并评价相关因素对MPN血栓形成的预测价值。结果血栓组年龄及MPV均高于无血栓组(P<0.05)。多因素logistic回归分析结果显示,LMR<3.67及MPV≥9.35是MPN患者发生血栓事件的独立危险因素(P<0.05)。ROC曲线分析结果示,LMR<3.67及MPV≥9.35两者联合预测MPN血栓形成的曲线下面积(AUC)均大于两者单独预测(P<0.05)。结论低LMR及高MPV与MPN血栓形成相关,LMR及MPV可作为MPN患者发生血栓事件的预测工具。

平均血小板体积/淋巴细胞比值与克罗恩病患者内镜评分、疾病活动度的关系

目的 探讨平均血小板体积/淋巴细胞比值(MPVLR)与克罗恩病患者内镜评分、疾病活动度的关系。方法 回顾性选取2020年10月—2022年10月收治的126例克罗恩病作为研究对象,根据入院时简化克罗恩病活动指数将患者分入活动组(n=49)和缓解组(n=77),同时对患者进行克罗恩病国内标准内镜评分分级。另选取同期体检的100例健康志愿者作为对照组。统计所有对象临床资料及入院时MPVLR。采用多因素Logistic回归分析克罗恩病患者疾病活动度的影响因素,采用受试者工作特征曲线下面积(AUC)分析MPVLR对克罗恩病患者疾病活动度的预测价值。结果 与内镜评分轻度患者比较,重度和中度患者MPVLR水平升高,且重度患者高于中度患者(P<0.05)。与对照组比较,活动组和缓解组MPVLR水平升高,且活动组高于缓解组(P<0.05)。平均血小板体积、淋巴细胞预测克罗恩病患者疾病活动度的AUC分别为0.740、0.851,MPVLR预测的AUC为0.915。活动组肛周病变、C反应蛋白>3 mg/L比例高于缓解组,而红细胞压积与平均红细胞体积低于缓解组(P<0.01)。肛周病变、C反应蛋白、MPVLR是影响克罗恩病患者疾病活动度的独立危险因素(P<0.01)。结论 高水平MPVLR能够影响克罗恩病患者的内镜评分分级和疾病活动度,检测MPVLR可能有助于确定克罗恩病的活动期,为临床诊疗提供依据。

AMI患者PLT、PDW、PLR水平及其与疾病严重程度的相关性研究

目的探讨急性心肌梗死(AMI)患者血小板计数(PLT)、血小板分布宽度(PDW)、血小板/淋巴细胞比值(PLR)水平及其与疾病严重程度的相关性。方法选取2017年1月至2020年12月苏州市相城区中医医院收治的200例AMI患者作为观察组,另选取同期150例常规体检健康者作为对照组。根据AMI患者随访结果又分为预后不良组和预后良好组。比较观察组和对照组,以及预后良好组和预后不良组PLT、PDW、PLR水平。采用多因素Logistic回归分析AMI患者预后的危险因素。采用Spearman相关分析Killip心功能分级与PLT、PDW、PLR水平的相关性;采用Pearson相关分析PLT、PDW、PLR水平的相关性。结果观察组PLT[(166.32±28.44)×10^(9)/L]高于对照组[(158.77±30.52)×10^(9)/L],PDW[(16.59±4.95)%]高于对照组[(15.54±3.01)%],PLR(162.40±78.85)高于对照组(114.74±12.34),差异均有统计学意义(P<0.05)。预后不良组和预后良好组性别、年龄、体质量指数、吸烟史、糖尿病、高血压、高血脂比较,差异均无统计学意义(P>0.05);预后不良组和预后良好组Killip心功能分级,PLT、PDW、PLR水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,PLT、PDW、PLR水平升高是AMI患者预后不良的独立危险因素(P<0.05)。Spearman相关分析结果显示,Killip心功能分级与PLT、PDW、PLR水平均呈正相关(r=0.702、0.664、0.302,P<0.05);Pearson相关分析结果显示,PLT水平与PDW、PLR水平均呈正相关(r=0.361、0.507,P<0.05),PDW水平与PLR水平呈正相关(r=0.596,P<0.05)。结论AMI患者PLT、PDW、PLR水平均升高,并且与AMI患者的Killip心功能分级均呈正相关,PLT、PDW、PLR可作为预测AMI患者预后的良好指标,对预防和治疗AMI有重要临床意义。

外周血中性粒细胞计数与淋巴细胞和血小板比值对老年脓毒症患者28天死亡的预测价值

目的 探讨外周血中性粒细胞计数与淋巴细胞和血小板比值(N/LPR)对老年脓毒症患者28 d死亡的预测价值。方法 根据入院28 d是否死亡将161例脓毒症患者分为生存组(108例)和死亡组(53例),收集其一般临床资料、入院24 h内的外周血中性粒细胞(NEU)、淋巴细胞(LYM)、PLT计数及N/LPR、NLR并分组进行比较。相关因素分析采用多因素logistic回归分析。采用受试者工作特征(ROC)曲线评价各指标对老年脓毒症患者预后的预测价值。结果 生存组外周血LYM、PLT计数均显著高于死亡组,而女性患者比例、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、NEU、NLR、N/LPR均显著低于死亡组(P<0.05)。多因素logistic回归分析结果显示,N/LPR、NLR降低是老年脓毒症患者28 d内死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,当N/LPR最佳截断值为18.5时,对应敏感度及特异度分别高于当NLR最佳截断值为21.73时对应的敏感度和特异度,且N/LRP的预测价值优于NLR。结论 N/LPR是老年脓毒症患者28 d死亡的独立危险因素,其预测价值优于NLR。

中性粒细胞与淋巴细胞比率、血小板计数联合D-二聚体对重症肺炎合并脓毒症患儿预后的预测价值

目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。