急性脑出血后中性粒细胞与淋巴细胞比值在预测患者神经功能恶化中的价值研究

The predictive value of neutrophil to lymphocyte ratio for neurological deterioration after acute intracerebral hemorrhage

目的探讨外周免疫细胞亚群计数及中性粒细胞与淋巴细胞比值(NLR)在预测急性脑出血(AICH)后神经功能恶化(ND)的价值。方法分析本院收治的87例AICH患者的临床资料。根据AICH后1w内有无ND进展将患者分为神经功能恶化组(ND组24例,占27.6%)和无神经功能恶化组(非ND组63例,占72.4%),并比较2组患者在入院时的外周免疫细胞亚群计数、NLR比值的差异性及与ND发生的相关性。结果 ND组患者的白细胞计数、中性粒细胞计数均高于非ND组患者,分别为10.80±4.44vs8.02±2.24(P<0.001)和9.23±4.97vs5.02±1.87(P<0.001),而淋巴细胞计数低于非ND组患者1.45±0.58vs2.43±1.87(P=0.025),故ND组患者的NLR比值明显高于非ND组患者9.45±5.40vs3.28±1.94(P<0.001)。通过回归分析发现AICH后外周血细胞计数、NLR比值与ND的发生密切相关(OR:1.87,95%CI:1.45~2.23),P<0.001)。根据ROC曲线下面积证实NLR比值(面积为0.872,P<0.001)对ND发生的预测价值高于白细胞计数、中性粒细胞和淋巴细胞计数(面积分别为0.749,0.823和0.721,均P<0.001)。结论 NLR比值的升高对预测AICH后ND的发生具有重要的临床价值,能够为AICH患者的预后管理提供理论依据。

Objective To investigate immunity plays a critical role in pathophysiology of acute intracerebral hemorrhage(AICH).This study aims to investigate the predictive value of peripheral leukocyte count and neutrophilto-lymohocyte ratio(NLR)for neurological deterioration(ND)after AICH.Method This study retrospectively collected eighty-seven cases of patients with AICH who were admitted to our hospital.By the occurrence of ND with one week after AICH,the patients were grouped into two groups,ND(twenty-four cases,27.6%)and non-ND(sixtythree cases,72.4%)respectively.And then compared peripheral leukocyte count and NLR between two groups through the blood test which were performed at admission immediatedly.Results Patients in ND group had higher whith blood cell count and neutrophil count than patients in non-ND group(10.80±4.44 vs 8.02±2.24)(P<0.001)and(9.23±4.97 vs 5.02±1.87)(P<0.001),respectively,but lymphocyte count was lower than non-ND group(1.45±0.58 vs 2.43±1.8)(P=0.025),as a reslut,the NLR in ND group was significantly higher than in non-ND group(9.45±5.40 vs 3.28±1.94)(P<0.001).The regression analysis confirmed that peripheral leukocyte count and NLR were closely associated with the occurance of ND in AICH patients(OR:1.87,95%CI:1.45-2.23)(P<0.001).Through ROC curve analysis,NLR,whose area under the curve was 0.872(P<0.001),had the best discriminating variable for the occurance of ND after AICH than white blood cell count,neutrophil count,and lymphocyte count,whose area under the curve were 0.749,0.823,0.721 respectively(P<0.001).Conclusion The increasion of NLR plays a significant role in predicting the occurance of ND after AICH and provide a guide of prognostic monitor for AICH patients.