aSAH后迟发性脑缺血NLR动态变化研究

Dynamic Change of NLR for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage

目的分析动脉瘤性蛛网膜下腔出血(aSAH)后中性粒细胞/淋巴细胞比值(NLR)的动态变化,了解其与迟发性脑缺血(delayed cerebral ischemia,DCI)发生之间的关系,并评估其预测价值。方法回顾性收集2019年12月~2020年12月在徐州医科大学附属医院收治的123例aSAH患者入院时临床资料及入院后3±1天、入院后6±1天、入院后9±1天的中性粒细胞计数、淋巴细胞计数以及中性粒细胞/淋巴细胞比值(NLR),根据DCI发生情况,将患者分为DCI组(48例)和非DCI组(75例),比较两组患者入院时的临床资料并通过重复测量方差分析比较两组不同时间中性粒细胞计数、淋巴细胞计数、NLR。运用ROC曲线及二元Logistic回归确定NLR对DCI的预测效能及相关性。结果DCI组在Hunt-Hess分级、WFNS分级、入院时平均动脉压、血小板计数、中性粒细胞计数均高于非DCI组,而DCI组在GCS评分低于非DCI组,差异均有统计学意义(P<0.05);DCI组患者在各个时间点中性粒细胞计数、NLR均高于非DCI组患者(P<0.05),并在发病后6±1天达到高峰,而淋巴细胞DCI组在入院后3±1天、6±1天、9±1天淋巴细胞计数均低于非DCI组(P<0.05),且在3±1天降至最低,组别与时间之间均存在交互作用(P<0.05)。且3±1天NLR对于DCI的预测效能更大,控制相关混杂变量后,NLR的升高仍是DCI发生的预测因素(OR=11.103,95%CI:3.777~32.117)。结论aSAH后NLR是动态变化的,其变化与DCI发生具有相关性。

Objective To explore the relationship between the dynamic change of neutrophil-lymphocyte ratio(NLR)and the occurrence of delayed cerebral ischemia(DCI)after aneurysmal subarachnoid hemorrhage(aSAH),and evaluate its value in prediction.Methods A total of 123 aSAH cases treated in the Affiliated Hospital of Xuzhou Medical University between December 2019and December 2020 were retrospectively collected for clinical data,and neutrophil count,lymphocyte count and NLR(3±1)days,(6±1)days and(9±1)days after admission.The patients were divided into the DCI group(48 cases)and non-DCI group(75 cases)based on the occurrence of DCI.The two groups were compared for clinical data at admission,and the ANOVA for repeated measurement was used for a comparison between the two groups in neutrophil count,lymphocyte count and NLR at different time points.ROC curve and binary Logistic regression were used to determine the prediction efficiency and correlation of NLR to DCI.Results The Hunt-Hess grade,WFNS grade,Platelet count,mean arterial pressure at admission and neutrophil count in DCI group were higher than in non-DCI group,while the GCS score in DCI group was lower than in non-DCI group,and the differences were statistically significant(P<0.05).The neutrophil count and NLR in DCI group were higher than in non-DCI group at all time points(P<0.05),and peaked(6±1)days after the onset,while the lymphocyte count in DCI group was lower than in non-DCI group(3±1)days,(6±1)days,and(9±1)days after admission(P<0.05),and at minimum(3±1)days after admission.There was an interaction between group and time(P<0.05).Moreover,(3±1)days NLR is more effective in predicting DCI.After controlling the relevant confounding variables,the increase of NLR is still a predictive factor for DCI(OR=11.103,95%CI:3.777-32.117).Conclusion NLR is a dynamic variable,and its variation is associated with occurrence of DCI.