Clinical Significance Of Preoperative T Cell Subsets,NLR And PLR In Predicting The Severity Of Cholecystitis

Objective:To explore the clinical significance of T cell subsets,ratio of neutrophils to lymphocytes(NLR)and ratio of platelets to lymphocytes(PLR)in predicting the severity of cholecystitis,and to analyze the correlation of T cell subsets,NLR and PLR in evaluating the severity of cholecystitisMethod:From July 2018 to June 2019,245 patients with cholecystitis who received laparoscopic cholecystectomy in hepatobiliary surgery of Yanbian University Affiliated Hospital were selected in sequence,including 102 males and 143 females.According to the duration of the patients,114 patients were classified as acute cholecystitis and 131 as chronic cholecystitis.According to the clinical manifestations,hematological examination,imaging examination and pathological report,the patients were divided into single group There were 57 cases of pure cholecystitis,107 cases of suppurative cholecystitis and 81 cases of gangrenous cholecystitis.The baseline data of each group were collected:sex,age,hospital stay,days of drainage tube placement,etc.;the T cell subsets and Blood Routine Indexes in the peripheral blood before operation were detected,and the values of NLR and PLR were calculated.To explore the relationship between the patient’s sex,age,T cell subsets(CD3,CD4,CD8,’CD4/CD8),NLR,PLR and cholecystitis;the relationship between the patient’s length of stay,the days of drainage tube placement and CD3,CD4,CD8,CD4/CD8,NLR,PLR;to analyze the correlation between T cell subsets(CD3,CD4,CD8,CD4/CD8)and NLR and PLR in peripheral blood,and to make statistics on the results AnalysisResults:There were 245 patients with cholecystitis(102 males,143 females,age range 23-87 years old,average age 62.2± 14.9 years old,hospital stay range 2-15 days,average hospital stay 7.2±2.5 days,133 patients with drainage tubes,placing time range 3-10 days,average placing time 4.8 ± 1.4 days).The age of patients with acute cholecystitis was significantly higher than that of patients with chronic cholecystitis(P<0.05).The proportion of women in chronic cholecystitis was significantly higher than that in acute cholecystitis(P<0.05).The levels of CD3,CD4 and CD8 in the peripheral blood of the patients with acute cholecystitis were significantly lower than those of the patients with chronic cholecystitis(P<0.05),while the levels of CD4/CD8 in the patients with acute and chronic cholecystitis were not statistically significant(P>0.05),and the levels of NLR and PLR in the patients with acute cholecystitis were significantly higher than those in the patients with chronic cholecystitis(P<0.05)There was statistical significance(P<0.05).The length of stay and the days of drainage tube placement were negatively correlated with CD3,CD4 and CD8(P<0.05),but not with CD4/CD8(P>0.05),and positively correlated with NLR and PLR(P<0.05).The levels of CD3,CD4 and CD8 in the peripheral blood of patients with suppurative cholecystitis and gangrenous cholecystitis before operation were lower than those of patients with simple cholecystitis,the difference was statistically significant(P<0.05).The levels of CD3,CD4,CD8 and CD4/CD8 in peripheral blood of patients with gangrenous cholecystitis were lower than those of patients with suppurative cholecystitis(P<0.05).The preoperative NLR and PLR of patients with suppurative cholecystitis and gangrenous cholecystitis were higher than those of patients with simple cholecystitis,the difference was statistically significant(P<0.05).The preoperative NLR and PLR of gangrenous cholecystitis were higher than those of suppurative cholecystitis(P<0.05).The T cell subsets CD3,CD4 and CD8 in peripheral blood were negatively correlated with NLR and PLR before operation,the difference was statistically significant(P<0.05);CD4/CD8 had no statistical significance in NLR and PLR(P>0.05).The AUC of CD3,CD4 and CD8 were 0.759,0.737 and 0.761,respectively.The AUC of NLR and PLR were 0.920 and 0.928,respectively.The AUC of CD3,CD4 and CD8 were 0.759,0.737,0.761,respectively.The AUC of NLR and PLR were 0.920 and 0.928,respectively.Conclusion:1.Preoperative NLR and PLR have high accuracy in predicting gangrenous cholecystitis,which can be used as predictive indicators.CD3,CD4,and CD8 have certain accuracy in predicting gangrenous cholecystitis and have certain predictive significance.2.The decrease of CD3,CD4,and CD8 levels of T cell subsets in peripheral blood before operation,accompanied by the increase of NLR and PLR levels,indicates that the severity of cholecystitis is aggravated,which has certain evaluation significance for the severity of cholecystitis.