Zhang Yukun, Cao Mingyu, Ren Jun
Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University Urumqi, Xinjiang Uygur Autonomous Region, China.
Department of Joint Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University Urumqi, Xinjiang Uygur Autonomous Region, China.
Am J Transl Res. 2021 Jun 15;13(6):7156-7163. eCollection 2021.
To investigate the value of the neutrophil-to-lymphocyte ratio (NLR) and Interleukin 18 (IL-18) level in patients with deep vein thrombosis after receiving surgery for spinal degeneration; and we explore their significance in clinical practice.
This study was conducted in 296 patients who were treated in our hospital for spinal degeneration. After surgery, these patients were followed up for 1 month. After performing the color Doppler ultrasound examination, patients were divided into the thrombus group (n = 72) and the non-thrombus group (n = 224) based on the occurrence of deep vein thrombosis. Baseline data, NLR values and IL-18 levels before surgery, and at 1, 3, 5, and 7 days after surgery were compared between the two groups. Logistic regression analysis was implemented to analyze the risk factors for postoperative deep vein thrombosis. Patients in the thrombosis group were allocated to the mild, moderate, and severe group on the basis of the degree of thrombosis. NLR values and IL-18 levels at 3 days after surgery were compared among the three groups. The correlations between both NLR value and IL-18 level and the severity of deep vein thrombosis were analyzed with Pearson correlation. Receiver operating characteristic curve was used to assess the clinical value of NLR value and IL-18 level at 3 days after surgery in predicting postoperative deep vein thrombosis.
There were significant differences concerning age, the history of diabetes, and obesity between the two groups (all P<0.05). NLR values and IL-18 levels in both groups after surgery were increased when compared with before surgery (all P<0.01). In addition, NLR values and IL-18 levels reached a peak at 3 days after surgery. Compared with the non-thrombus group, NLR values and IL-18 levels in the thrombus group at 1, 3, 5, and 7 days after surgery were increased (all P<0.01). NLR value and IL-18 level in the thrombosis group at 3 days after surgery were increased with a worsened degree of thrombosis. In other words, both NLR value and IL-18 level were positively correlated with the degree of deep vein thrombosis. The results of logistic regression analysis displayed that age ≥60 years old, body mass index ≥23 kg/m, NLR value >4.34%, and IL-18 level >115.71 ng/mL were independent risk factors for postoperative deep vein thrombosis. The results of the ROC curve showed that the area under curves, which represent the formation of postoperative deep vein thrombosis, were above 0.7 when using NLR value and IL-18 level at 3 days after surgery (both P<0.001).
Compared with the non-thrombus group, NLR value and IL-18 level in the thrombosis group after receiving surgery for spinal degeneration are significantly increased. In addition, the more severe the thrombosis is, the higher the NLR value and IL-18 level at 3 days after surgery. Therefore, NLR value and IL-18 level at 3 days after surgery have certain clinical value in predicting postoperative deep vein thrombosis and prognosis.
探讨中性粒细胞与淋巴细胞比值（NLR）及白细胞介素18（IL - 18）水平在脊柱退变手术后深静脉血栓形成患者中的价值，并探讨其在临床实践中的意义。
本研究纳入296例在我院接受脊柱退变手术治疗的患者。术后对这些患者进行1个月的随访。在进行彩色多普勒超声检查后，根据深静脉血栓形成情况将患者分为血栓组（n = 72）和无血栓组（n = 224）。比较两组患者的基线数据、术前及术后1、3、5和7天的NLR值及IL - 18水平。采用Logistic回归分析术后深静脉血栓形成的危险因素。血栓组患者根据血栓程度分为轻度、中度和重度组。比较三组术后3天的NLR值及IL - 18水平。采用Pearson相关性分析NLR值和IL - 18水平与深静脉血栓严重程度的相关性。采用受试者工作特征曲线评估术后3天NLR值和IL - 18水平预测术后深静脉血栓形成的临床价值。
两组患者在年龄、糖尿病史和肥胖方面存在显著差异（均P<0.05）。两组术后NLR值和IL - 18水平均较术前升高（均P<0.01）。此外，NLR值和IL - 18水平在术后3天达到峰值。与无血栓组相比，血栓组术后1、3、5和7天的NLR值和IL - 18水平均升高（均P<0.01）。血栓组术后3天的NLR值和IL - 18水平随血栓程度加重而升高。即NLR值和IL - 18水平均与深静脉血栓程度呈正相关。Logistic回归分析结果显示，年龄≥60岁、体重指数≥23 kg/m、NLR值>4.34%和IL - 18水平>115.71 ng/mL是术后深静脉血栓形成的独立危险因素。ROC曲线结果显示，术后3天使用NLR值和IL - 18水平预测术后深静脉血栓形成的曲线下面积均>0.7（均P<0.001）。
与无血栓组相比，脊柱退变手术后血栓组的NLR值和IL - 18水平显著升高。此外，血栓越严重，术后3天的NLR值和IL - 18水平越高。因此，术后3天的NLR值和IL - 18水平在预测术后深静脉血栓形成及预后方面具有一定的临床价值。
