动脉瘤性蛛网膜下腔出血急性期中性粒细胞/淋巴细胞比值、血糖/血钾比值与神经功能缺损程度的相关性及预测价值

Correlation and predictive value of neutrophil/lymphocyte ratio,blood glucose/blood potassium ratio with neurological impairment in acute stage of aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血急性期检验指标联合中性粒细胞/淋巴细胞比值(NLR)、血糖/血钾比值(Glu/K+)对动脉瘤性蛛网膜下腔出血(aSAH)患者的神经缺损程度的相关性,预测影响患者病情的独立危险因素。方法回顾性分析2019年1月至2022年5月入住牡丹江医学院附属红旗医院的110例aSAH患者的临床资料。根据改良Rankin量表(mRS)评分把患者分为轻度组(58例)和中重度组(52例),先进行单因素分析,比较两组的一般临床资料、急性期检验指标,包括血压、血糖、中性粒细胞计数、淋巴细胞计数、血小板计数、血清钾离子浓度等,并计算NLR、血小板与淋巴细胞比值(PLR)、Glu/K+,将有统计学意义的参数设为自变量进行多因素logistic回归分析。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析NLR、Glu/K+对aSAH患者神经功能缺损程度的预测作用。结果中重度组的Glu高于轻度组,血小板(Plt)低于轻度组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,aSAH患者的白细胞计数(WBC)、Glu、Glu/K+、中性粒细胞(N)、NLR与mRS评分呈正相关(P<0.05)。多元线性回归分析结果显示NLR、Glu/K+与mRS评分独立相关。多因素logistic回归分析显示,Glu/K+为mRS评分的独立预测因素。ROC曲线分析显示,NLR和Glu/K+预测aSAH患者神经功能缺损程度的最佳临界值分别为2.82、2.96,AUC分别为0.607、0.602,敏感度分别为56.9%、47.1%,特异度分别为67.2%、71.6%。结论NLR、Glu/K+可作为动脉瘤性蛛网膜下腔出血评估病情的有效预测因素。

Objective To investigate the correlation between the acute stage test index,neutrophil/lymphocyte ratio(NLR)and glucose/potassium ratio(Glu/K+)on the degree of nerve defect in patients with aneurysmal subarachnoid hemorrhage(aSAH),and to predict the independent risk factors affecting the condition of the patients.Methods Clinical data of 110 patients with aSAH admitted to Hongqi Hospital Affiliated to Mudanjiang Medical University from January 2019 to May 2022 were retrospectively analyzed.According to the modified Rankin scale(mRS)score,the patients were divided into mild group(58 cases)and moderate and severe group(52 cases).First,unifactor analysis was performed to compare the general clinical data and acute stage test indicators of the two groups,including blood pressure,blood glucose,neutrophil count,lymphocyte count,platelet count,serum potassium ion concentration,etc.NLR,platelite-lymphocyte ratio(PLR),Glu/K+,and so on.Statistically significant parameters were set as independent variables for multivariate logistic regression analysis.Receiver operating characteristic(ROC)curve was plotted and area under the curve(AUC)was calculated to analyze the predictive effect of NLR and Glu/K+on the degree of neurological impairment in aSAH patients.Results Glu in moderate to severe group was higher than that in mild group,and platelet(Plt)was lower than that in mild group,the differences were statistically significant(P<0.05).Spearman correlation analysis showed that the white blood cell count(WBC),Glu,Glu/K+,neutrophil(N),NLR in aSAH patients were positively correlated with mRS Score(P<0.05).Multiple linear regression analysis showed that NLR and Glu/K+were independently correlated with mRS scores.Multiple logistic regression analysis showed that Glu/K+was an independent predictor of mRS scores.ROC curve analysis showed that the optimal critical values of NLR and Glu/K+for predicting the degree of neurological impairment in aSAH patients were 2.82 and 2.96,AUC was 0.607 and 0.602,sensitivity was 56.9%and 47.1%,specificity was 67.2%and 71.6%,respectively.Conclusion NLR and Glu/K+can be used as effective predictors of aneurysmal subarachnoid hemorrhage.