系统性炎性反应指标对颅脑创伤患者短期疗效的预测价值

Predictive value of systemic inflammatory factors for short-term outcome of patients with craniocere-bral trauma

目的探讨系统性炎性反应指标对颅脑创伤(TBI)患者短期疗效的预测价值。方法回顾性分析2019年1—12月华中科技大学同济医学院附属同济医院神经外科收治的74例经手术治疗的TBI患者的临床资料。于TBI后24 h内对患者进行系统性炎性反应指标[包括白细胞、中性粒细胞、淋巴细胞、单核细胞、中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、预后营养指数]检测。术后1个月采用格拉斯哥预后评级(GOS)评估患者的短期疗效,并分为疗效良好(GOSⅣ、Ⅴ级)和疗效差(GOSⅠ~Ⅲ级)两组。采用单因素和多因素logistic回归分析筛选影响TBI患者短期疗效的危险因素。绘制受试者工作特征(ROC)曲线并计算曲线下面积,以评估系统性炎性反应指标对TBI患者预后的预测价值。结果74例TBI患者中,术后短期疗效良好者55例(74.3%),疗效差者19例(25.7%)。单因素分析结果显示,头颅CT显示中线移位≥1 cm、术前格拉斯哥昏迷评分(GCS)、血糖、低钙血症、白细胞、中性粒细胞、单核细胞、血小板、NLR、dNLR、PLR和MLR均为TBI患者短期疗效的影响因素(均P<0.05)。多因素logistic回归分析结果显示,TBI患者早期出现低钙血症(OR=0.001,95%CI:0~0.376)、白细胞计数≥14.2×109/L(OR=0.005,95%CI:0~0.604)、单核细胞计数≥0.9×109/L(OR=0.012,95%CI:0~0.385)和NLR≥12.8(OR=0.001,95%CI:0~0.603)均为患者短期疗效差的危险因素(均P<0.05)。白细胞+单核细胞的预测能力最强,曲线下面积为0.801(95%CI:0.697~0.905),其灵敏度和特异度分别为84.2%和72.7%。结论系统性炎性反应指标中,白细胞与单核细胞计数联合分析对TBI患者短期疗效的预测价值较高。

Objective To investigate the predictive value of systemic inflammatory factors on short-term outcome of traumatic brain injury(TBI)patients.Methods A retrospective analysis was conducted on the clinical data of 74 patients with TBI treated by surgery who were admitted to the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January to December 2019.Systemic inflammatory response factors,including white blood cell count,neutrophil count,lymphocyte count,monocyte count,neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),derived NLR(dNLR),platelet-to-lymphocyte ratio(PLR),and prognostic nutritional index,were evaluated within 24 hours after TBI.The Glasgow outcome scale(GOS)was used to evaluate the short-term efficacy of the patients at 1 month after the operation,and they were divided into two groups:good outcome(GOSⅣ,Ⅴ)and poor outcome(GOSⅠ-Ⅲ).Univariate and multivariate logistic regression analysis were used to screen independent risk factors for short-term efficacy in TBI patients.A receiver operating characteristic(ROC)curve was drawn and the area under the curve was calculated to evaluate the predictive value of systemic inflammatory factors for the prognosis of TBI patients.Results Among 74 patients with TBI,55 cases(74.3%)had good short-term outcomes,and 19 cases(25.7%)had poor outcomes.Univariate analysis showed that midline shift≥1 cm on brain CT,preoperative Glasgow coma score(GCS),blood glucose,hypocalcemia,white blood cells,neutrophils,monocytes,platelets,NLR,dNLR,PLR and MLR were all closely related to the short-term efficacy of TBI patients(all P<0.05).Multivariate logistic regression analysis showed that early hypocalcemia(OR=0.001,95%CI:0-0.376),white blood cell count≥14.2×109/L(OR=0.005,95%CI:0-0.604),monocyte count≥0.9×109/L(OR=0.012,95%CI:0-0.385)and NLR≥12.8(OR=0.001,95%CI:0-0.603)in TBI patients were independent risk factors for poor short-term efficacy(all P<0.05).White blood cells+monocytes had the strongest predictive values.The area under the curve was 0.801(95%CI:0.697-0.905),and the sensitivity and specificity were 84.2%and 72.7%respectively.Conclusion Among the systemic inflammatory factors,the combined analysis of white blood cell and monocyte counts has a relatively higher predictive value for the short-term outcome of TBI patients.