高血压性脑出血外周血炎症标志物与术后30天病死率的关系

Relationship of peripheral blood inflammatory markers with 30-day mortality after surgery in the patients with hypertensive intracerebral hemorrhage

目的探讨外周血炎症标志物与高血压性脑出血术后30 d病死率的关系。方法回顾性分析2012~2015年手术治疗的215例高血压性脑出血的临床资料,采用受试者工作特征(ROC)曲线法与Logistic回归分析检验炎症标志物与术后30 d病死率的关系。结果术后30 d死亡34例。多因素Logistic回归分析后结果表明,血肿体积较大、术后第7天淋巴细胞数较高、术后第3天淋巴细胞/单核细胞比值(LMR)较高、术后第7天LMR较高是高血压性脑出血病人术后30 d死亡的危险因素(P<0.05)。ROC曲线分析结果显示,术后第3、7天外周血LMR预测术后30 d死亡的临界值分别为1.23和1.13,其特异性、敏感性分别为70.70%、87.34%和96.60%、86.20%。结论高血压脑性出血病人术后30 d死亡与血肿体积、外周血淋巴细胞及LMR密切相关,调整LMR或许可以改善病人预后。

Objective To evaluate the relationship between the peripheral blood inflammatory markers such as lymphocyte-monocyte ratio （LMR） and 30-day mortality after the surgery in patients with hypertensive intracerebral hemorrhage （HICH）. Methods The clinical data of 215 patients with HICH treated by surgery in our hospital from 2012 to 2015 were analyzed retrospectively. Of these 215 patients, 34 died and 181 survived within 30 days after the treatment. The relationship of the peripheral inflammatory markers with 30-day mortality after the treatment was analyzed. Results The hematoma volume was significantly bigger and the numbers of neutrophil per liter blood 3 days after the surgery and monocyte per liter blood 7 days after the surgery, and neutrophil-lymphocyte ratio 3 and 7 days after the surgery were significantly higher in the dead patients than those in the survival patients within 30 days after the treatment （P〈0.05）. The number of lymphocyte per liter blood and LMR 3 and 7 days after the surgery, and preoperative platelet count and platelet-lymphocyte ratio were significantly lower in the dead patients than those in the survival patients within 30 days after the treatment（P〈0.05）. The multivariate analysis suggested that hematoma volume, absolute lymphocyte count 7 days after the surgery, and LMR 3 and 7 days after the surgery were related to the death within 30 days after the surgery in the patients with HICH （P〈0.05）. Conclusion The low level of postoperative peripheral blood LMR was risk factor of 30-day mortality after the surgery in the patients with HICH.