联勤保障部队第九〇九医院(厦门大学附属东南医院)神经外科，福建 漳州 363000
刘长春（1984—），男，汉，本科，从事神经外科相关工作。
王文浩，男，主任医师，Email：cwtao1983@126.com。
Department of Neurosurgery，The 909th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation， Zhangzhou， Fujian 363000， China
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目的 探讨术前血小板相关参数对胶质瘤患者肿瘤复发的预测作用。方法 分析联勤保障部队第九〇九医院2015—2017年收治的93例胶质瘤患者临床病理资料，根据随访期间肿瘤是否复发分为无复发组（n=52）和复发组（n=41），分析血小板相关参数与胶质瘤分级的相关性，采用ROC曲线分析血小板计数（PLT）、血小板体积分布宽度（PDW）、血小板压积(PCT)、平均血小板体积（MPV）、平均血小板体积/血小板计数（MPV/PLT）对肿瘤复发的预测作用，多因素Cox分析肿瘤复发的影响因素，采用Kaplan-Meier曲线分析这些因素对肿瘤复发的影响。结果 胶质瘤Ⅲ、Ⅳ级患者PLT、PCT、高于胶质瘤Ⅰ、Ⅱ级患者（t=-2.388、-2.335，均P<0.05）；胶质瘤Ⅲ、Ⅳ级患者中MPV、MPV/PLT低于胶质瘤Ⅰ、Ⅱ级患者（均P<0.05）；无复发组患者PLT和PCT低于复发组（均P<0.05）；无复发组患者MPV和MPV/PLT高于复发组（均P<0.05）；PLT的ROC曲线下面积（UAC）为0.630（95%CI=0.517~0.743，P=0.032），阈值为216×109/L；MPV的UAC为0.633（95%CI=0.518~0.747，P=0.029），阈值为8.65 fL；MPV/PLT的UAC为0.731（95%CI=0.626~0.835，P<0.001），阈值为0.040；多因素分析结果发现，肿瘤分级（Ⅲ、Ⅳ）、MPV≤8.65 fL、MPV/PLT≤0.040是术后肿瘤复发的危险因素（95%CI分别为1.778~3.530、1.730~4.450、1.811~6.067，均P<0.05）；肿瘤分级（Ⅲ、Ⅳ）预测术后肿瘤复发曲线下面积为0.679（95%CI=0.569~0.789，P=0.003）。Kaplan-Meier曲线分析显示，MPV≤8.65 fL患者术后3年复发率高于MPV>8.65 fL患者（Long Rank=10.990，P=0.001）；MPV/PLT≤0.040患者术后3年复发率高于MPV/PLT>0.040患者（Long Rank=6.289，P=0.012）。结论 胶质瘤患者术前MPV和MPV/PLT与术后肿瘤复发有关，可以用于肿瘤预后预测，具有一定临床意义。 [国际神经病学神经外科学杂志, 2023, 50(4): 29-33]
Objective To investigate the effect of preoperative platelet-related parameters in predicting tumor recurrence in patients with glioma.Methods A retrospective analysis was performed for the clinicopathological data of 93 patients with glioma who were admitted to The 909th Hospital of Joint Logistics Support Force from 2015 to 2017， and according to the presence or absence of tumor recurrence during follow-up， they were divided into non-recurrence group with 52 patients and recurrence group with 41 patients. The correlation between platelet-related parameters and glioma grade was analyzed； the receiver operating characteristic （ROC） curve was used to analyze the effect of platelet count （PLT）， platelet distribution width （PDW）， plateletcrit （PCT）， mean platelet volume （MPV）， and MPV/PLT ratio in predicting tumor recurrence， and the Kaplan-Meier curve was used to investigate the influence of these factors on tumor recurrence.Results Compared with the patients with grade Ⅰ/Ⅱ glioma， the patients with grade III/IV glioma had significantly higher PLT and PCT （both P <0.05） and significantly lower MPV and MPV/PLT ratio （both P <0.05）. Compared with the recurrence group， the non-recurrence group had significantly lower PLT and PCT （both P <0.05） and significantly higher MPV and MPV/PLT ratio （both P <0.05）. The ROC analysis showed that PLT had an area under the ROC curve （AUC） of 0.630 （95% confidence interval ［CI］： 0.517-0.743， P = 0.032） and a threshold of 216×109/L， MPV had an AUC of 0.633 （95% CI： 0.518-0.747， P = 0.029） and a threshold of 8.65 fL， and MPV/PLT ratio had an AUC of 0.731 （95% CI： 0.626-0.835， P <0.001） and a threshold of 0.040. The multivariate analysis showed that tumor grade （III-IV） （95% CI： 1.778-3.530， P <0.05）， MPV ≤8.65 fL （95% CI： 1.730-4.450， P <0.05）， MPV/PLT ratio ≤0.040 （95% CI： 1.811-6.067， P <0.05） were risk factors for postoperative tumor recurrence， and tumor grade （Ⅲ-Ⅳ） had an AUC of 0.679 （95% CI： 0.569-0.789， P = 0.003） in predicting postoperative tumor recurrence. The Kaplan-Meier curve analysis showed that the patients with MPV ≤ 8.65 fL had a significantly higher 3-year recurrence rate than those with MPV >8.65 fL （Long Rank = 10.990， P = 0.001）， and the patients with MPV/PLT ≤0.040 had a significantly higher 3-year recurrence rate than those with MPV/PLT >0.040 （Long Rank = 6.289， P = 0.012）.Conclusions Preoperative MPV and MPV/PLT ratio are associated with postoperative tumor recurrence in patients with glioma， and therefore， they have a certain clinical significance and can be used for predicting the prognosis of tumor. ［Journal of International Neurology and Neurosurgery, 2023, 50(4): 29-33］
引用本文
刘长春,付亮,王文浩456.血小板相关参数对胶质瘤患者预后的影响[J].国际神经病学神经外科学杂志,2023,50(4):29-33111LIU Changchun, FU Liang, WANG Wenhao222. Influence of platelet-related parameters on the prognosis of patients with glioma[J]. Journal of International Neurology and Neurosurgery,2023,50(4):29-33
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- 收稿日期:2022-04-12
- 最后修改日期:2023-06-17
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- 在线发布日期: 2023-09-22
