外周血白细胞计数、C反应蛋白/白蛋白比值与动脉瘤性蛛网膜下腔出血患者短期预后相关性研究

Correlation between peripheral blood white blood cell count,C-reactive protein/albumin ratio and short-term prognosis in patients with aneurysmal subarachnoid hemorrhage

目的探讨外周血白细胞(WBC)计数、C反应蛋白/白蛋白(CRP/ALB)比值变化与动脉瘤性蛛网膜下腔出血(aSAH)患者短期预后的相关性。方法选取自2018年1月至2020年6月收治的138例aSAH患者为研究对象,根据格拉斯哥预后量表(GOS)评分将患者分为预后良好组(n=101)与预后不良组(n=37),比较两组患者的临床资料。采用多因素Logistic回归分析影响aSAH患者预后的相关因素;应用受试者工作特征(ROC)曲线分析WBC、CRP/ALB比值对aSAH患者短期预后的评估价值。结果138例aSAH患者中,预后不良患者37例(26.8%),预后良好患者101例(73.2%)。单因素分析结果显示,高血压病史、Hung-Hess分级、改良Fisher分级、动脉瘤直径、治疗方式、急性脑积水、迟发性脑缺血、WBC、CRP/ALB比值与aSAH患者预后有关(P<0.05)。多因素Logistic回归分析结果显示,高血压病史、Hung-Hess分级(Ⅳ~Ⅴ级)、改良Fisher分级(Ⅲ~Ⅳ级)及外周血WBC、CRP/ALB比值升高是影响aSAH患者预后的独立危险因素(P<0.05)。ROC曲线结果显示,外周血WBC预测aSAH患者不良预后的曲线下面积为0.811,敏感度和特异度分别为0.733和0.762;CRP/ALB比值预测aSAH患者不良预后的曲线下面积为0.806,敏感度和特异度分别为0.800和0.667;两项联合检测预测aSAH患者不良预后的曲线下面积为0.898,敏感度和特异度分别为0.867和0.859。结论外周血WBC计数、CRP/ALB比值升高是aSAH患者不良预后的重要危险因素,两者水平变化有助于评估aSAH患者的预后。

Objective To investigate the relationship between peripheral blood white blood cell(WBC)count,C-reactive protein/albumin(CRP/ALB)ratio and the prognosis of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A retrospective study was performed on 138 cases of patients with aSAH who were admitted from January 2018 to June 2020.According to Glasgow outcome scale(GOS)score,the patients were divided into good prognosis group and poor prognosis group,and the clinical data of the two groups were compared.Multivariate Logistic regression was used to analyze the related factors affecting the prognosis of aSAH patients.Receiver operating characteristic(ROC)curve was used to analyze the value of WBC and CRP/ALB ratio in evaluating the short-term prognosis of aSAH patients.Results Among 138 aSAH patients,37 patients(26.8%)had poor prognosis and 101 patients(73.2%)had good prognosis.Univariate analysis showed that history of hypertension,Hung-hess grade,modified Fisher grade,aneurysm diameter,treatment approach,acute hydrocephalus,delayed cerebral ischemia(DCI),WBC and CRP/ALB ratio were related to prognosis of patients with aSAH(P<0.05).Multiariable Logistic regression analysis results showed that the history of high blood pressure,Hung-Hess classification(Ⅳ-Ⅴlevel),improved Fisher classification(Ⅲ-Ⅳlevel),peripheral blood WBC and elevated CRP/propagated ratio were the independent risk factors affecting the prognosis of patients with aSAH(P<0.05).The ROC curve results showed that the area under the curve of peripheral blood WBC for predicting poor prognosis in aSAH patients was 0.811,and the sensitivity and specificity were 0.733 and 0.762,respectively.The area under the curve of CRP/ALB ratio for predicting poor prognosis in aSAH patients was 0.806,and the sensitivity and specificity were 0.800 and 0.667,respectively.The area under the curve of the two combined tests for predicting adverse outcomes in patients with aSAH was 0.898,and the sensitivity and specificity were 0.867 and 0.859,respectively.Conclusion Peripheral blood WBC count and elevated CRP/ALB ratio are important risk factors for poor prognosis in patients with aSAH.Changes in the two levels help to predict the prognosis of aSAH patients.