背景:术后中枢性尿崩症(CDI)通常见于颅咽管瘤(CP)患者,炎症反应在CPs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CPsCDI发生的预测价值。
方法:回顾性分析208例接受手术治疗的CP患者的临床资料,包括术前外周炎症指标。术前外周血白细胞(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率(NLR),派生NLR(dNLR),在总共208例CP患者以及不同年龄和手术方式的CP患者亚组中评估了单核细胞与淋巴细胞比率(MLR)和PLT与淋巴细胞比率(PLR).通过受试者操作员特征曲线分析评估其预测值。
结果:术前外周白细胞,中性粒细胞,NLR,dNLR,MLR,与PLR呈正相关,淋巴细胞与CP患者术后CDI的发生呈负相关,特别是当白细胞≥6.66×109/L或淋巴细胞≤1.86×109/L时同时,多因素logistic回归分析显示,年龄>18岁的患者WBC>6.39×109/L,经颅入路患者WBC>6.88×109/L或淋巴细胞≤1.85×109/L与术后CDI发生率升高密切相关。此外,从受试者操作特征曲线分析获得的曲线下面积显示,炎症标志物的最佳预测因子是总CP患者的NLR,≤18岁年龄组和经蝶窦组的MLR,>18岁年龄组的NLR和经颅组的dNLR。值得注意的是,NLR+dNLR组合指数在所有组中显示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的有希望的预测因子。
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 × 109/L or lymphocyte ≤ 1.86 × 109/L. Meanwhile, multiple logistic regression analysis showed that WBC > 6.39 × 109/L in the > 18 yrs age patients, WBC > 6.88 × 109/L or lymphocytes ≤ 1.85 × 109/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.