Beliaev Andrei M, Angelo Neville, Booth Michael, Bergin Colleen
Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Grafton, Auckland, New Zealand.
Surgical Pathology Unit, North Shore Hospital, Takapuna, Auckland, New Zealand.
J Surg Res. 2017 Mar;209:93-101. doi: 10.1016/j.jss.2016.09.034. Epub 2016 Sep 29.
The diagnosis of acute cholecystitis (AC) is frequently associated with an increase in white cell count (WCC) and C-reactive protein (CRP). However, one or both of these inflammatory biomarkers can be normal in AC. The aim of this study was to evaluate and compare the discriminative powers of the neutrophil-to-lymphocyte ratio (NLR) with WCC and CRP in diagnosing AC.
This was a retrospective cohort study. For more than a period of 5 y, 1959 patients were identified from the cholecystectomy Registry. Laparoscopic cholecystectomy patients with histologic evidence of AC were included if they also had preoperative WCC and CRP measurements. Eligibility criteria were met by 177 patients. These patients were compared with 45 control subjects who had normal gallbladder histology.
One unit of increase in the NLR was associated with a 2.5 times increase in the odds of AC (odds ratio = 2.48; 95% confidence interval [CI], 1.5-4.1; P < 0.0005). NLR cutoff values of 4.1 (95% CI, 3.42-4.79), 3.25 (95% CI, 1.95-4.54), and 4.17 (95% CI, 3.76-4.58) were diagnostic for the overall AC, mild, and moderate-severe AC, respectively. The NLR areas under the receiver operating characteristic curve in AC, mild, and moderate-severe AC were 94% (95% CI, 91%-97%), 87% (95% CI, 81%-93%), and 98% (95% CI, 96%-100%), respectively. The discriminative power of an NLR was superior to that of the WCC and similar to CRP for diagnosing AC and different grades of severity.
NLR can be considered as a potential inflammatory biomarker for AC.
急性胆囊炎（AC）的诊断通常与白细胞计数（WCC）和C反应蛋白（CRP）升高有关。然而，在AC患者中，这两种炎症生物标志物中的一种或两种可能正常。本研究的目的是评估和比较中性粒细胞与淋巴细胞比值（NLR）与WCC和CRP在诊断AC中的鉴别能力。
这是一项回顾性队列研究。在超过5年的时间里，从胆囊切除术登记处识别出1959例患者。如果腹腔镜胆囊切除术患者有AC的组织学证据且术前测量了WCC和CRP，则纳入研究。177例患者符合纳入标准。将这些患者与45例胆囊组织学正常的对照受试者进行比较。
NLR每增加1个单位，AC发生几率增加2.5倍（优势比=2.48；95%置信区间[CI]，1.5-4.1；P<0.0005）。NLR临界值4.1（95%CI，3.42-4.79）、3.25（95%CI，1.95-4.54）和4.17（95%CI，3.76-4.58）分别对总体AC、轻度AC和中度-重度AC具有诊断意义。AC、轻度AC和中度-重度AC的受试者工作特征曲线下NLR面积分别为94%（95%CI，91%-97%）、87%（95%CI，81%-93%）和98%（95%CI，96%-100%）。在诊断AC及其不同严重程度分级方面，NLR的鉴别能力优于WCC，与CRP相似。
NLR可被视为AC潜在的炎症生物标志物。
