入院时中性粒细胞/淋巴细胞比值及即刻血糖水平对急性脑出血患者短期预后的预测价值

Predictive value of neutrophil/lymphocyte ratio and immediate blood glucose level on short-term prognosis in patients with acute cerebral hemorrhage

目的探讨入院时中性粒细胞/淋巴细胞(NLR)及即刻血糖水平(ABG)对急性脑出血患者短期预后不良的预测价值。方法选取2017年1月~2018年12月辽宁省盘锦辽油宝石花医院收治的193例急性脑出血患者,根据90 d改良Rankin量表评分将其分为预后不良组(87例)和预后良好组(106例)。比较两组临床特征,生化检测结果及影像学资料,logistic回归分析急性脑出血短期预后的影响因素,ROC曲线分析NLR和ABG对急性脑出血患者短期预后不良的预测价值。结果两组年龄、饮酒史、糖尿病病史、美国国立卫生研究院卒中量表评分比较,差异有统计学意义(P<0.05)。预后不良组中性粒细胞计数、白细胞计数、ABG、NLR、出血破入脑室患者比例及血肿体积均高于预后良好组,淋巴细胞计数低于预后良好组(P<0.05)。多因素logistic回归分析发现,ABG[OR=2.569,95%CI(1.569,5.574),P=0.002]和NLR[OR=1.549,95%CI(1.103,3.265),P=0.005]是急性脑出血患者预后不良的高危因素。ABG对急性脑出血短期预后不良诊断的曲线下面积为0.867,95%CI(0.819,0.915),截断值为5.95 mol/L,灵敏度、特异性分别为0.805、0.725;NLR对急性脑出血短期预后不良诊断的ROC曲线下面积为0.824,95%CI(0.655,0.794),截断值为2.76,灵敏度、特异性分别为0.897、0.453。结论上升的ABG和NLR水平是急性脑出血短期预后不良的危险因素,检测两指标可以预测患者短期预后情况。

Objective To explore the predictive value of neutrophillymphocyte(NLR)and admission blood glucose(ABG)in the short-term poor prognosis of patients with acute cerebral hemorrhage.Methods A total of 193 patients with acute cerebral hemorrhage admitted to Panjin Liaohe Oilfield Gem Flower Hospital,Liaonig Province from January2017 to December 2018 were divided into two groups:the poor prevention group(87 cases)and the good prognosis group(106 cases)according to the 90 day modified Rankin scale.The clinical characteristics,biochemical test results and imaging data of the two groups were compared.The influencing factors of short-term prognosis of acute cerebral hemorrhage was analyzed by logistic regression.ROC curve was used to analyze the predictive value of NLR and ABG for short-term poor prognosis of patients with acute cerebral hemorrhage.Results There were significant differences in age,drinking history,diabetes history,the national institutes of health stroke scale score between the two groups(P<0.05).The proportion of neutrophil count,white blood cell count,ABG,NLR,hematoma volume and the proportion of haemorrhage into ventricle in the poor prognosis group were higher than those in the good prognosis group,and the lymphocyte count was lower than that in the good prognosis group(P<0.05).Logistic analysis showed that ABG(OR=2.569,95%CI[1.569,5.574],P=0.002)and NLR(OR=1.549,95%CI[1.103,3.265],P=0.005)were the high risk factors of poor prognosis in patients with acute cerebral hemorrhage.The area under the curve of ABG in the diagnosis of shortterm poor prognosis of acute cerebral hemorrhage was 0.867,95%CI(0.819,0.915),the cutoff value was 5.95 mol/L,the sensitivity and specificity were 0.805 and 0.725.The area under the curve under ROC curve of NLR in the diagnosis of short-term poor prognosis of acute cerebral hemorrhage was 0.824,95%CI(0.655,0.794),the cutoff value was2.76,the sensitivity and specificity were 0.897 and 0.453.Conclusion The rising ABG and NLR levels are the risk factors of poor short-term prognosis in patients with acute cerebral hemorrhage.The short-term prognosis of patients can be predicted by detecting the two indexes.