中性粒细胞/淋巴细胞比值、单核细胞/淋巴细胞比值与血小板/淋巴细胞比值对老年髋部骨折患者术后谵妄的预测价值研究  

Predictive values of neutrophil to lymphocyte ratio,monocyte to lymphocyte ratio and platelet to lymphocyte ratio for delirium after hip fracture surgery in the elderly

作　　者：王晓伟[1] 孙天胜 刘智 张建政[1] 赵建文 Wang Xiaowei;Sun Tiansheng;Liu Zhi;Zhang Jianzheng;Zhao Jianwen(Department of Orthopaedics,The 7th Medical Center,General Hospital of Chinese People's Liberation Army,100700C,hina)

机构地区：[1]解放军总医院第七医学中心骨科,北京100700

出　　处：《中华创伤骨科杂志》2022年第11期950-956,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目(82172389)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)与血小板/淋巴细胞比值(PLR)对老年髋部骨折患者术后谵妄的预测价值。方法回顾性分析2012年1月至2018年12月解放军总医院第七医学中心骨科收治的1278例老年髋部骨折患者资料。男418例,女860例;中位年龄81(75,90)岁;股骨转子间骨折728例,股骨颈骨折550例。绘制NLR、MLR、PLR预测老年髋部骨折后谵妄发生的受试者工作特征曲线(ROC),并分别得到最佳截断点(敏感度、特异度和曲线下面积),根据最佳截断点分别将NLR、MLR、PLR分成升高组和正常组。根据髋部骨折术后是否发生谵妄,将患者分为谵妄组与无谵妄组,首先进行单因素分析,对于P<0.05的因素再采用二元逻辑回归分析确定危险因素。结果1278例老年髋部骨折患者入院时NLR、MLR、PLR中位数分别为5.43(3.87,7.88)、0.40(0.29,0.54)、158.40(118.00,222.50)。术后共153例(12.0%)患者发生谵妄,利用ROC曲线研究NLR、MLR、PLR预测老年髋部骨折患者术后谵妄的最佳截断点(敏感度、特异度和曲线下面积)分别为7.613(57.5%、77.1%、0.726)、0.512(52.3%、74.0%、0.663)、201.125(68.6%、73.3%、0.751)。其中NLR升高(OR=2.046,95%CI:1.322~3.166,P<0.001)、MLR升高(OR=1.568,95%CI:1.039~2.367,P=0.032)、PLR升高(OR=3.489,95%CI:2.290~5.317,P<0.001)是术后谵妄发生的危险因素。结论NLR≥7.613、MLR≥0.512和PLR≥201.125是老年髋部骨折患者术后发生谵妄的危险因素,NLR、MLR和PLR对术后谵妄预测具有较强的临床应用价值。Objective To explore the predictive values of neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR)and platelet to lymphocyte ratio(PLR)for postoperative delirium in the elderlypatients with hipfracture.MethodsThedata of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics,The 7th Medical Center,General Hospital of Chinese People's Liberation Army from January2012 to December 2018.There were 418males and 860females,with a median age of 81(75,90)years.There were 728 intertrochanteric fractures and 550 femoral neck fractures.The working characteristic curves(ROC)of NLR,MLR,and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points(sensitivity,specificity,and area under the curve)respectively.According to the best cutoff points,the NLR,MLR,and PLR were respectively divided into an increase group and a normal group.According to whether postoperative delirium occurred or not,the patients were divided into a delirium group and a delirium-free group.After univariable analysis was conducted to screen out the risk factors,binary logistic regression analysis was conducted of thefactors withP<0.05 to determine the risk factors.Results Themedianvalues of NLR,MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43(3.87,7.88),0.40(0.29,0.54)and 158.40(118.00,222.50),respectively.Postoperative delirium occurred in 153 patients(12.0%).In the study of the predictive values of NLR,MLR,and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture,the best cutoff points(sensitivity,specificity,and area underthecurve)forpredictionwere7.613(57.5%,77.1%,0.726),0.512(52.3%,74.0%,0.663),and 201.125(68.6%,73.3%,0.751),respectively.The risk factors for postoperative delirium were increased NLR(OR=2.046,95%Cl:1.322 to 3.166,P<0.001),increased MLR(0R=1.568,95%Cl:1.039to 2.367,P=0.032),and increased PLR(0R=3.489,95%Cl:2.290

关 键 词：髋骨折 老年 谵妄 淋巴细胞 单核细胞 

分 类 号：R687.3[医药卫生—骨科学]