术前外周炎性标志物可预测颅咽管瘤患者术后中枢性尿崩症：一项回顾性研究。
Preoperative peripheral inflammatory markers are predictors of postoperative central diabetes insipidus in craniopharyngioma patients: a retrospective study.
机构信息
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
出版信息
BMC Cancer. 2024 May 8;24(1):572. doi: 10.1186/s12885-024-12324-4.
BACKGROUND
Postoperative central diabetes insipidus (CDI) is commonly observed in craniopharyngioma (CP) patients, and the inflammatory response plays an important role in CPs. We aimed to evaluate the predictive value of preoperative peripheral inflammatory markers and their combinations regarding CDI occurrence in CPs.
METHODS
The clinical data including preoperative peripheral inflammatory markers of 208 CP patients who underwent surgical treatment were retrospectively collected and analyzed. The preoperative peripheral white blood cells (WBC), neutrophils, lymphocytes, monocytes, platelet (PLT), neutrophil-to-lymphocyte ratio (NLR), derived-NLR (dNLR), monocyte-to-lymphocyte ratio (MLR) and PLT-to-lymphocyte ratio (PLR) were assessed in total 208 CP patients and different age and surgical approach CP patient subgroups. Their predictive values were evaluated by the receiver operator characteristic curve analysis.
RESULTS
Preoperative peripheral WBC, neutrophils, NLR, dNLR, MLR, and PLR were positively correlated and lymphocyte was negatively associated with postoperative CDI occurrence in CP patients, especially when WBC ≥ 6.66 × 10/L or lymphocyte ≤ 1.86 × 10/L. Meanwhile, multiple logistic regression analysis showed that WBC > 6.39 × 10/L in the > 18 yrs age patients, WBC > 6.88 × 10/L or lymphocytes ≤ 1.85 × 10/L in the transcranial approach patients were closely associated with the elevated incidence of postoperative CDI. Furthermore, the area under the curve obtained from the receiver operator characteristic curve analysis showed that the best predictors of inflammatory markers were the NLR in total CP patients, the MLR in the ≤ 18 yrs age group and the transsphenoidal group, the NLR in the > 18 yrs age group and the dNLR in the transcranial group. Notably, the combination index NLR + dNLR demonstrated the most valuable predictor in all groups.
CONCLUSIONS
Preoperative peripheral inflammatory markers, especially WBC, lymphocytes and NLR + dNLR, are promising predictors of postoperative CDI in CPs.
背景
颅咽管瘤（CP）患者术后常发生中枢性尿崩症（CDI），炎症反应在 CP 中起重要作用。我们旨在评估术前外周炎症标志物及其组合对 CP 患者 CDI 发生的预测价值。
方法
回顾性收集并分析了 208 例接受手术治疗的 CP 患者的临床资料，包括术前外周炎症标志物。在 208 例 CP 患者和不同年龄及手术入路 CP 患者亚组中评估了术前外周白细胞（WBC）、中性粒细胞、淋巴细胞、单核细胞、血小板（PLT）、中性粒细胞与淋巴细胞比值（NLR）、衍生 NLR（dNLR）、单核细胞与淋巴细胞比值（MLR）和血小板与淋巴细胞比值（PLR）。通过受试者工作特征曲线分析评估其预测价值。
结果
CP 患者术后外周 WBC、中性粒细胞、NLR、dNLR、MLR 和 PLR 与 CDI 发生呈正相关，而淋巴细胞与 CDI 发生呈负相关，尤其是当 WBC≥6.66×10/L 或淋巴细胞≤1.86×10/L 时。同时，多因素逻辑回归分析显示，>18 岁患者中 WBC>6.39×10/L、经颅入路患者中 WBC>6.88×10/L 或淋巴细胞≤1.85×10/L 与术后 CDI 发生率升高密切相关。此外，受试者工作特征曲线分析得到的曲线下面积显示，在所有 CP 患者中，炎症标志物的最佳预测因子是 NLR，在≤18 岁组和经蝶窦组中是 MLR，在>18 岁组和经颅组中是 NLR，在所有组中 dNLR 的预测价值均优于 NLR。值得注意的是，NLR+dNLR 的联合指数在所有组中表现出最有价值的预测因子。
结论
术前外周炎症标志物，尤其是 WBC、淋巴细胞和 NLR+dNLR，是 CP 术后 CDI 的有前途的预测因子。
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