入院NLR与外伤性脑内血肿扩大及病人预后的关系

Association of admission NLR with hematoma expansion and 3-month prognosis of patients with traumatic intracerebral haemorrhage

目的探讨入院中性粒细胞/淋巴细胞比值(NLR)与外伤性脑出血(tICH)血肿扩大及病人预后的相关性。方法2019年7月至2021年8月前瞻性收集tICH病人共115例。根据入院血常规计算NLR。伤后3个月,根据改良Rankin量表评分评估预后,0~2分为预后良好。血肿扩大定义为二次CT扫描与基线CT扫描相比体积增加33%或>5 ml。结果115例中,13例(11.30%)发生血肿扩大。伤后3个月,41例(35.65%)预后不良,74例(64.35%)预后良好。多因素logistic回归分析显示,血肿扩大以及入院NLR水平增高为tICH病人预后不良的独立危险因素(P<0.05),入院NLR水平增高是血肿扩大的独立危险因素(P<0.001)。ROC曲线分析显示,入院NLR水平评估血肿扩大的AUC为0.896(95%CI 0.821~0.971;P<0.001),入院NLR水平评估tICH病人伤后3个月预后不良的曲线下面积为0.709(95%CI 0.615~0.802;P<0.05)。结论tICH血肿扩大影响病人预后,神经炎症参与tICH进展。入院NLR对tICH血肿扩大、病人预后具有一定的评估价值。NLR临床极易获取,因此NLR是评估tICH病情的一个有价值的指标。

Objective To analyze the correlation between admission neutrophil/lymphocyte ratio(NLR)and hematoma expansion and 3-month prognosis of patients with traumatic intracerebral haemorrhage(tICH).Methods A total of 115 patients with tICH were prospectively recruited from July 2019 to August 2021.NLR was calculated based on the admission blood routine test.At 3 months post injury,the prognosis was evaluated according to the modified Rankin scale,with a score of 0~2 as good prognosis.Hematoma enlargement was defined as a 33%or>5 ml increase in volume on the second CT scan compared to the baseline CT scan.Results Of 115 patients,13 patients(11.30%)suffered from hematoma expansion.At 3 months after injury,41 patients(35.65%)had poor prognosis and 74(64.35%)had good prognosis.Multivariate logistic regression analysis showed that hematoma expansion and admission NLR increase were independent risk factors for poor prognosis of tICH patients(P<0.05),and admission NLR increase was an independent risk factor for hematoma expansion in tICH patients(P<0.001).ROC curve analysis showed that the AUC of the admission NLR level to assess the hematoma expansion was 0.896(95%CI 0.821~0.971;P<0.001),and the AUC of the admission NLR level to assess the poor prognosis of tICH patients 3 months after injury was 0.709(95%CI 0.615~0.802;P<0.05).Conclusions Hematoma expansion affects the prognosis of patients with tICH,and the neuroinflammation is involved in the progression of tICH.Admission NLR has a certain value in evaluating hematoma expansion and prognosis of patients with tICH.NLR is easily accessible clinically,so NLR is a valuable indicator for evaluating the condition of patients with tICH.