中性粒细胞/淋巴细胞对原发性急性脑出血老年患者短期预后的预测价值

Predictive value of neutrophil/lymphocyte in the short-term prognosis of elderly patients with primary acute intracerebral hemorrhage

目的探讨入院时外周血中性粒细胞/淋巴细胞(neutrophil/lymphocyte,N/L)对原发性急性脑出血(acute cerebral hemorrhage,AICH)老年患者短期预后的预测价值.方法回顾性分析2020年10月—2021年10月徐州医科大学附属医院收治的原发性AICH老年患者155例,根据90 d改良Rankin评分量表(modified Rankin Scale,mRS)评分分为预后良好组(mRS评分≤2分,92例)和预后不良组(mRS评分>2分,63例).收集和比较两组患者临床资料、影像学特征和实验室资料,采用Logistic回归分析对组间差异有意义的变量进行分析,确定90 d预后不良的独立危险因素.应用受试者工作特征(receiver operating characteristic,ROC)曲线分析N/L对原发性AICH老年患者预后不良的预测价值.结果预后不良组美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、出血破入脑室占比、血肿体积、WBC计数、绝对中性粒细胞计数(absolute neutrophil count,ANC)、N/L高于预后良好组(P<0.05).其他指标组间差异无统计学意义(P>0.05).Logistic回归分析结果显示,NIHSS评分[比值比(odds ratio,OR)1.108,95%CI 1.048~1.172,P<0.001]、N/L(OR 1.342,95%CI 1.178~1.528,P<0.001)是原发性AICH老年患者预后不良的独立危险因素.N/L预测AICH老年患者预后不良的ROC曲线下面积为0.794(95%CI 0.723~0.866,P<0.001),截断值为5.36,灵敏度、特异性分别为79.4%、66.3%;NIHSS评分预测AICH老年患者预后不良的ROC曲线下面积为0.722(95%CI0.640~0.804,P<0.001),截断值为16.50,灵敏度、特异性分别为79.4%、67.4%.结论N/L和NIHSS评分是原发性AICH老年患者短期预后不良的独立危险因素,具有较好的预测价值.

Objective To explore the predictive value of peripheral blood neutrophillymphocyte(N/L)in the short-term prognosis of elderly patients with primary acute cerebral hemorrhage.Methods A total of 155 elderly patients with primary acute cerebral hemorrhage who were admitted to the Affliated Hospital of Xuzhou Medical University from October 2020 to October 2021 were enrolled.According to the 90 d modified Rankin Scale(mRS)scores,they were divided into two groups:a good prognosis group(mRS scores≤2 points,n=92)and a poor prognosis group(mRS scores>2 points,n=63).Both groups were compared for clinical data,imaging features and laboratory data.The variables with statistical diferences between the groups were analyzed by binary logistic regression analysis to determine the independent risk factors for poor prognosis within 90 d.Finally,the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of N/L to primary acute cerebral hemorrhage in elderly patients.ResultsCompared with the good prognosis group,the poor prognosis group presented remarkable increases in the National Institutes of Health StrokeScale(NIHSS)score,the proportion of bleeding into the ventricles,hematoma volume,white blood cell(WBC)counts,absolute neutrophil count(ANC),and N/L(P<0.05).There were no statistical dfferences in other indicators(P>0.05).According to binary logistic regression analysis,he NIHSS score[odds ratio(OR)1.108,95%confidence interval(CI) 1.048,1.172,P<0.001]and N/L[0R 1.342,95%CI 1.178,1.528,P<0.001]were the independent risk factors for poor prognosis in elderly patients with primary acute intracerebral hemorrhage.The ROC curve analysis showed that the area under the cure for the N/L curve was 0.794(95%CI 0.723,0.866,P<0.001),with a cutoff value of 5.36,a sensitivity of 79.4%and a specificity of 66.3%.The ROC curve analysis showed that the area under the cure for the NIHSS score curve was 0.722(95%CI 0.640,0.804,P<0.001),with a cutoff value of 16.50,a sensitivity of 79.4%and a speificity of 67.4%.Conclusion The N/L and NIHSS score is an independent rsk factor for the short-term poor prognosis in elderly women with primary acute intracerebral hemorhage,with good predictive value.