头部磁共振成像联合外周血检测中性粒细胞与淋巴细胞比值对脑白质疏松严重程度的诊断价值分析

Analysis on the diagnostic value of head MRI combined with the NLR for the LA severity

目的:分析头部磁共振成像(MRI)联合外周血检测中性粒细胞与淋巴细胞比值(NLR)对脑白质疏松(LA)严重程度的诊断价值。方法:选择医院接收治的98例LA患者,按照Fazekas视觉等级标准将其分为轻度组(29例)、中度组(32例)和重度组(37例)。同期选择45例非LA患者为非LA组。所有患者均行MRI检查,测量平均弥散率(MD)与表观弥散系数(ADC)值。采集患者外周血检测NLR,对比每组患者MD、ADC及NLR值,采用Logistic风险比例回归模型及受试者工作特征(ROC)曲线分析MD、ADC联合NLR检测对LA严重程度的诊断价值。结果:中度组与重度组患者NLR及MD较非LA组升高,差异有统计学意义(t_(NLR)=3.272,t=3.817;t_(MD)=7.295,t=6.883;P<0.05),重度组NLR水平高于轻度组与中度组,差异有统计学意义(t=3.780,t=2.926;P<0.05),重度组MD水平高于轻度组,差异有统计学意义(t=5.018,P<0.05)。与非LA组相比,轻度组、中度组及重度组患者ADC值提高,差异有统计学意义(t=3.784,t=3.272,t=3.817;P<0.05)。Logistic风险比例回归模型显示,ADC为预测轻度LA患者的独立危险因素(OR=18.935,P<0.05);NLR与MD均是预测中度LA的独立危险因素(OR=68.95,OR=1301853;P<0.05),进一步ROC曲线分析显示,NLR及MD联合诊断中度LA的ROC曲线下面积(AUC)为0.942,高于二者单独检测,差异有统计学意义(Z=2.513,P<0.05);NLR与MD均是预测重度LA的独立危险因素(OR=9.408,OR=1522;P<0.05),二者联合诊断重度LA的AUC为0.903,高于二者单独检测,差异有统计学意义(Z=2.996,P<0.05)。结论:NLR联合MRI的MD参数对于诊断中度、重度LA患者的效能显著高于单独诊断,NLR可为MRI提高LA诊断效能提供参考依据,帮助临床更准确的评估LA患者的病情程度,制定个性化治疗方案。

Objective:To analyze the diagnostic value of head magnetic resonance imaging(MRI)combined with the neutrophil to lymphocyte ratio(NLR)for the severity of leukoaraiosis(LA).Methods:A total of 98 LA patients who were diagnosed and treated in hospital were selected,and they were divided into mild group(29 cases),moderate group(32 cases)and severe group(37 cases)according to the Fazekas visual level standard.A total of 45 non-LA patients were selected as controls during the same period,and they were divided into non-LA group.All patients underwent MRI examination to measure the values of mean dispersion(MD)rate and apparent dispersion coefficient(ADC).The peripheral bloods of patients were collected to determine NLR,and the values of MD,ADC and NLR of each group were compared.The Logistic risk proportional regression model and receiver operating characteristic(ROC)were adopted to analyze the diagnostic value of the combination of MD,ADC and NLR for the LA severity.Results:The levels of NLR and MD in the moderate and severe groups were significantly higher than those in the non-LA group(t_(NLR)=3.272,t=3.817,t_(MD)=7.295,t=6.883,P<0.05),and the NLR levels of severe group was significantly higher than that of mild group and moderate group(t=3.780,t=2.926,P<0.05),respectively.The MD level of severe group was significantly higher than that of mild group(t=5.018,P<0.05).The ADC values of patients in the mild,moderate and severe groups were significantly higher than that of non-LA group(t=3.784,t=3.272,t=3.817,P<0.05),respectively.The Logistic proportional risk regression model showed that only ADC was an independent risk factor of predicting mild LA(OR=18.935,P<0.05),and both NLR and MD were independent risk factors of predicting moderate LA(OR=68.95,OR=1301853,P<0.05).The further analysis of ROC curve indicated that the area under curve(AUC)value of the combined diagnosis of NLR and MD was 0.942 for moderate LA,which was significantly higher than that of the each single examination of NLR and MD(Z=2.513,P<0.05).Both NLR and MD were independent risk factors of predicting severe LA(OR=68.95,OR=1301853,P<0.05).The AUC value of the combined diagnosis of NLR and MD was 0.903 for severe LA,and the diagnostic efficiency of the combination was significantly higher than that of single examination of NLR and MD(Z=2.996,P<0.05).Conclusion:The diagnostic efficiency of MD parameters of NLR combined with MRI is significantly higher than that of single diagnosis for moderate and severe LA patients,and NLR can assist MRI to improve the diagnostic efficiency for LA,which can contribute clinically medical staffs to more accurately assess the disease condition of LA patients and formulate individual treatment plan.