中性粒细胞/淋巴细胞比值和血肿周围水肿体积是脑出血患者预后的独立预测因素

Neutrophil/Lymphocyte Ratio and Perihematoma Edema Volume Are Independent Prognostic Predictors of Patients with Intracerebral Haemorrhage

目的:探讨中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与脑出血(intracerebral hemorrhage,ICH)后血肿周围水肿(perihematomal edema,PHE)体积及预后的相关性。方法:回顾性收集ICH患者,根据随访出院后90 d改良Rankin量表(modified Rankin Scale,mRS)评分分为预后良好(mRS≤3分)组和预后不良(m RS>3分)组。比较2组人口统计学、临床基线资料及影像学资料等。应用Pearson相关性分析NLR和PHE体积的相关性;多因素Logistic回归分析确定影响预后不良的独立危险因素;受试者工作特征(receiver operating characteristic,ROC)曲线评估NLR和发病第7天PHE体积对预后不良的预测价值。结果:根据纳入及排除标准共纳入177例ICH患者,其中预后良好105例,预后不良72例。单因素分析显示预后不良组ICH 24 h内PHE体积、第7天PHE体积、24 h内相对PHE体积、第7天相对PHE体积、NLR、PLR明显高于预后良好组,预后不良组脑疝比例高于预后良好组(P<0.05)。Pearson相关性分析显示,ICH 24 h内PHE体积与发病24 h内血肿体积及NLR呈正相关(P<0.05);发病第7天PHE体积与NLR与发病24 h内血肿体积、发病第7天血肿体积、NLR呈正相关(P<0.05)。二元Logistic回归分析提示发病第7天PHE体积、NLR是ICH患者预后不良的独立危险因素(P<0.05)。ROC曲线发现发病第7天PHE体积曲线下面积为0.636(95%CI 0.54~0.73,P=0.006);NLR曲线下面积为0.676(95%CI 0.585~0.768,P<0.001)。结论:入院时NLR水平较高的ICH患者,PHE越严重,入院时NLR升高和发病第7天PHE体积是ICH患者出院第90天预后不良的危险因素。

Objective:To investigate correlation between the neutrophil-to-lymphocyte ratio(NLR)and perihematomal edema(PHE)volume and prognosis after intracerebral hemorrhage(ICH).Methods:Patients with ICH were retrospectively enrolled and divided into good prognosis(mRS≤3)and poor prognosis(mRS>3)groups according to the Modified Rankin Scale(mRS)scores obtained 90 days after discharge from the hospital.Demographics,clinical baseline data and imaging data were compared between the two groups.Pearson correlation analysis was applied to determine the correlation between NLR and PHE volume.Multivariate Logistic regression analysis was used to determine independent risk factors affecting poor prognosis.Receiver operating characteristic(ROC)curves were used to assess the predictive value of NLR and PHE volume at day 7 from onset on poor prognosis.Results:A total of 177 patients with ICH were included according to the inclusion and exclusion criteria,including 105 patients withgood prognosis and 72 patients with poor prognosis.Univariate analysis showed that PHE volume at 24 h,PHE volume at day 7,relative PHE volume at 24 h,relative PHE volume at day 7,NLR and PLR were significantly higher in the poor prognosis group than in the good prognosis group,and the proportion of brain herniation was significantly higher in the poor prognosis group than in the good prognosis group(P<0.05).Pearson correlation analysis showed that PHE volume within 24 h of ICH was positively correlated with haematoma volume and NLR within 24 h from onset(P<0.05);PHE volume and NLR on day 7 from onset were positively correlated with hematoma volume within 24 h of onset,hematoma volume on day 7 from onset,and NLR(P<0.05).Binary Logistic regression analysis suggested that PHE volume at day 7 from onset and NLR were independent risk factors for poor prognosis in patients with ICH.ROC analysis domonstrated an area under curve of 0.636(95%CI0.54~0.73,P=0.006)for PHE volume on day 7 from onset and 0.676(95%CI 0.585~0.768,P<0.001)for NLR.Conclusion:Higher NLR levels on admission correlated with more severe PHE.Elevated NLR on admission and PHE volume on day 7 from onset were risk factors for poor prognosis on day 90 post-discharge for patients with ICH.