外周血中性粒细胞/淋巴细胞比值对动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测价值研究

Predictive Value of Peripheral Blood Neutrophil/Lymphocyte Ratio on Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage

目的分析外周血中性粒细胞/淋巴细胞比值(NLR)对动脉瘤性蛛网膜下腔出血(aSAH)后迟发性脑缺血(DCI)的预测价值。方法选取2013—2016年重庆市三峡中心医院神经外科诊治的aSAH患者238例,根据aSAH后DCI发生情况分为发生DCI者65例(A组)和未发生DCI者173例(B组)。比较两组患者临床资料,aSAH后DCI的影响因素分析采用多因素Logistic回归分析,并绘制外周血NLR预测aSAH后DCI的ROC曲线。结果两组患者年龄、男性比例发病至入院时间、高血压发生率、糖尿病发生率、吸烟率、饮酒率、动脉瘤面积、多发动脉瘤者所占比例、红细胞计数、血红蛋白、血小板计数及手术方式比较,差异均无统计学意义(P>0.05);A组患者Hunt-Hess分级4~5级者所占比例、后循环动脉瘤发生率、改良Fisher分级3~4级者所占比例、脑积水发生率、白细胞计数、外周血NLR、血糖均高于B组(P<0.05)。NLR≥10.9者DCI发生率高于NLR<10.9者(P<0.05)。多因素Logistic回归分析结果显示,Hunt-Hess分级4~5级[OR=2.31,95%CI(1.27,4.19)]、改良Fisher分级3~4级[OR=1.46,95%CI(1.08,1.97)]、外周血NLR[OR=2.06,95%CI(1.31,3.24)]及血糖[OR=1.17,95%CI(1.06,1.35)]是aSAH患者DCI的独立危险因素(P<0.05)。ROC曲线显示,外周血NLR预测aSAH后DCI的曲线下面积(AUC)为0.74[95%CI(0.64,0.83),P<0.05],最佳截断值为11.2,灵敏度为69%,特异度为72%。结论外周血NLR是aSAH患者DCI的独立危险因素之一,且其对aSAH后DCI有一定预测价值。

Objective To analyze the predictive value of peripheral blood neutrophil/lymphocyte ratio(NLR) on delayed cerebral ischemia(DCI) in patients with aneurysmal subarachnoid hemorrhage(aSAH). Methods From 2013 to 2016,a total of 238 patients with aSAH were selected in the Department of Neurosurgery,Sanxia Central Hospital of Chongqing,and they were divided into A group(complicated with DCI,n = 65) and B group(did not complicated with DCI,n = 173)according to the incidence of DCI. Clinical data was compared between the two groups,influencing factors of DCI in patients with aSAH were analyzed by multivariate Logistic regression analysis,and ROC curve was drawn to evaluate the predictive value of peripheral blood NLR on DCI in patients with aSAH. Results No statistically significant differences of,age,male proporation duration between attack and admission,incidence of hypertension or diabetes, smoking rate, drinking rate, aneurysm area,proportion of patients with multi-aneurysm,RBC,Hb,PLT or surgical procedures was found between the two groups(P >0. 05); proportion of patients with 4 to 5 Hunt-Hess grading,incidence of posterior circulation aneurysm,proportion of patients with 3 to 4 modified Fisher grading,incidence of hydrocephalus,WBC,peripheral blood NLR and blood glucose of A group were statistically significantly higher than those of B group(P < 0. 05). Incidence of DCI in patients with peripheral blood NLR equal or over 10. 9 was statistically significantly higher than that in patients with peripheral blood NLR less than 10. 9(P <0. 05). Multivariate Logistic regression analysis results showed that,4 to 5 Hunt-Hess grading [OR = 2. 31,95% CI(1. 27,4. 19) ],3 to 4 modified Fisher grading [OR = 1. 46,95% CI(1. 08,1. 97) ],peripheral blood NLR [OR = 2. 06,95% CI(1. 31,3. 24) ]and blood glucose [OR = 1. 17,95% CI(1. 06,1. 35) ]were independent risk factors in patients with aSAH(P < 0. 05). ROC curve showed that,AUC of peripheral blood NLR in predicting DCI in patients with aSAH was 0. 74 [95% CI(0. 64,0. 83),P < 0. 05],the best cutoff was 11. 2,the sensitivity was 69%,the specificity was 72%. Conclusion Peripheral blood NLR in one of risk factors of DCI in patients with aSAH,peripheral blood NLR has certain predictive value on DCI in patients with aSAH.