文章摘要
中性粒细胞/淋巴细胞比值对老年胃癌根治术患者术后早期认知功能的预测价值
Predictive value of neutrophil/lymphocyte ratio in early post-operative neurocognitive function of elderly patients undergoing radical gastrectomy
  
DOI：10.12089/jca.2021.11.002
中文关键词: 术后认知功能障碍  中性粒细胞/淋巴细胞比值  胃癌根治术
英文关键词: Postoperative cognitive dysfunction  Neutrophil/lymphocyte ratio  Radical gastrectomy
基金项目:国家自然基金面上项目（81771171）；江苏省肿瘤医院院内面上项目（ZM201709）
作者单位E-mail
谢辉兰 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
张民皓 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
马丽丽 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
辜晓岚 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
顾连兵 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
王丽君 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科 w_lj2000@hotmail.com 
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中文摘要:
      
目的 探讨血清中性粒细胞/淋巴细胞比值（NLR）预测老年胃癌根治术患者术后认知功能障碍（POCD）的价值。
方法 选择择期行胃癌根治术患者100例，男67例，女33例，年龄≥65岁，ASA Ⅱ或Ⅲ级。患者手术均在气管插管全麻下进行，在术前及术后第7天通过Z计分法评估患者认知功能，根据评分
结果 将患者分为两组：POCD组和NPOCD组。记录术前1 d、术后1、3 d血清中NLR的变化。应用受试者工作特征（ROC）曲线，分析各时点血清NLR对老年胃癌根治术患者发生POCD的预测价值。
结果 术后7 d发生POCD患者22例（22%）。与术前1 d比较，术后1、3 d两组NLR明显升高（P<0.05）。术后1、3 d POCD组血清NLR明显高于NPOCD组（P<0.05）。术后3 d血清中NLR预测老年胃癌根治术患者发生POCD的最佳界值为6.986，预测POCD发生的AUC为0.818（95%CI 0.728～0.888），敏感性和特异性分别为88.5%和68.2%，高于术后1 d NLR的AUC为0.799（95%CI 0.707～0.872）。
结论 老年胃癌根治术患者术后3 d NLR对术后7 d POCD发生的预测价值较高，血清中NLR的升高可能与术后POCD的发生相关，术后NLR升高是发生POCD的危险因素。
英文摘要:
      
Objective To investigate the value of serum neutrophil/lymphocyte ratio (NLR) in predicting postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical gastrectomy of gastric cancer.
Methods A total of 100 elderly patients with gastric cancer radical gastrectomy, 67 males,33 females, aged ≥ 65 years, ASA physical status Ⅱ or Ⅲ, were assigned into the study. All patients were operated under endotracheal intubation and intravenous anesthesia. The cognitive function was evaluated by Z-score method before operation and the 7th day after operation, the patients were divided into POCD group and NPOCD group. Serum NLR levels were measured 1 day before surgery and 1, 3 days after surgery. The predictive value of serum NLR level for POCD in elderly patients undergoing radical gastrectomy was analyzed using ROC curve.
Results POCD occurred in 22 patients (22%) 7 days after operation. Compared with 1 day before surgery, NLR levels were significantly increased in both groups on 1, 3 days after surgery. Compared with the NPOCD group, serum levels of NLR were significantly increased in the POCD group 1, 3 days after surgery (P < 0.05). The ROC curve showed that the optimal threshold for predicting the occurrence of POCD the third day after surgery was 6.986, and the AUC of POCD was 0.818 (95% CI 0.728 - 0.888), higher than the AUC 0.799 (95%CI 0.707 - 0.872) of NLR 1 day after surgery. The sensitivity and specificity were 88.5% and 68.2%, respectively.
Conclusion The predictive value of NLR on the third day after radical gastrectomy for elderly patients with gastric cancer is relatively high for POCD occurrence. The increase of serum NLR level is related to the occurrence of postoperative POCD, while the increase of postoperative NLR level is a risk factor for POCD occurrence.
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