CD4^+/CD8^+比值与大脑半球大面积梗死预后的相关性研究

Correlation between the ratio of CD4^+/CD8^+ and clinical outcomes in patients with large hemispheric infarction

目的 探讨大面积脑梗死患者血清CD4^+/CD8^+比值与其预后的相关性。方法 选取郑州大学第一附属医院神经重症监护病房2016-03—2018-07收住的300例急性大脑半球大面积梗死患者为脑梗死组,同期健康体检者300例入对照组。脑梗死组于发病24h采血,对照组于入组时采血,检测T淋巴细胞亚群及血常规,同时脑梗死组送检C反应蛋白、血脂、空腹血糖、尿酸、同型半胱氨酸、胆红素等。脑梗死组入院即行格拉斯哥昏迷评分,发病30d随访以改良的Rankin量表(MRS)评定预后,记录受试者性别、年龄、既往史、个人史等基本情况。结果 脑梗死组CD4^+/CD8^+比值1.33±0.43,较对照组1.94±0.29明显降低。根据MRS评分预后分组,预后不良组CD4^+/CD8^+比值1.22±0.436,预后良好组1.57±0.286,2组差异有统计学意义(P<0.05);Logistic回归分析示,CD4^+/CD8^+比值、LDLC、CRP及GCS评分是引起大脑半球大面积梗死预后不良的独立影响因素;ROC曲线示,CD4^+/CD8^+比值可预测脑梗死预后,AUC为0.886,95%CI为0.836~0.936,预测能力很好。以约登指数最大时的cutoff值1.215为预测大面积脑梗死预后不良的最佳切点,此时的敏感度为0.753,特异度为0.929,Youden指数0.682。结论 CD4+/CD8+比值是大面积脑梗死患者短期预后不良的独立影响因素。

Objective To explore the relationship between the ratio of CD4^+/CD8^+ and the clinical outcomes of patients with large hemispheric infarction. Methods The patients with acute cerebral hemisphere infarction admitted to the Department of Neurological Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from March 2016 to July 2018 were enrolled.According to the 2015 American Society of Neurological Intensive Diseases,the large area hemisphere infarction was issued.Management Guide,the LHI group was enrolled in 300 cases,and 300 physical examinations were randomly matched according to age and gender into the control group.In the LHI group,5 ml of antithrombotic vein was collected from the elbow vein 24h after the onset of the disease.The control group was enrolled with 5 mL of blood to detect T lymphocyte subsets and blood routine.The LHI group was sent for C reactive protein,blood lipids,fasting blood glucose,uric acid,homocysteine,bilirubin and the like.A physician recorded the gender,age,past history,and personal history of the subjects.GCS score were performed in the LHI group.The LHI group underwent a 30 day MRS score. Results The ratio of CD4 ^+/CD8^+ LHI group (1.33±0.43) was significantly lower compared to the control group (1.94±0.29);According to the MRS score prognosis group,the ratio of CD4 ^+/CD8 ^+ was 1.22±0.436 in the poor prognosis group and the ratio of CD4 ^+/CD8^+ was 1.57±0.286 in the prognosis group.The difference between the two groups was statistically significant;Logistic regression analysis showed that the ratio of CD4^+/CD8^+,LDL C,CRP and GCS scores were independent risk factors for poor prognosis of large area infarction in the cerebral hemisphere;ROC curve results show that the ratio of CD4 ^+/CD8^+ predicts cerebral infarction,the AUC is 0.886,and the 95% CI is 0.836 to 0.936.The prediction ability is very good.The best cut off point for predicting poor prognosis of large area cerebral infarction was the cut off value of 1.215 at the time of the Yoden index.The sensitivity was 0.753,the specificity was 0.929,and the youden index was 0.682. Conclusion The ratio of CD4^+/CD8^+ is an independent predictor of poor prognosis.