单核细胞和高密度脂蛋白比值对颅内动脉瘤性蛛网膜下腔出血患者预后的预测价值研究

Predictive value of monocyte to high-density lipoprotein ratio for prognosis of patients with aneurysmal subarachnoid hemorrhage

目的探讨单核细胞和高密度脂蛋白比值(MHR)对颅内动脉瘤性蛛网膜下腔出血(aSAH)患者预后的预测价值。方法回顾性选取2020年1月至2022年12月嘉兴大学附属第二医院神经外科收治的aSAH患者87例。患者均经头颅CT及脑血管造影检查确诊为aSAH并作相应干预,发病24 h内留取血液标本进行血常规和生化检测,出院后3个月随访时采用改良Rankin评分评估预后。比较预后不良患者与预后良好患者临床特征;分析患者预后不良的危险因素;分析MHR对患者预后不良的预测效能。结果预后不良患者24例,预后良好患者63例。预后不良患者与预后良好患者性别、吸烟史、饮酒史、既往史、治疗方式、CRP、淋巴细胞计数、TG、TC、白蛋白、肌酐等比较差异均无统计学意义(均P>0.05),而年龄、病情Hunt-Hess分级、Glasgow昏迷量表(GCS)评分、血糖、中性粒细胞计数、单核细胞计数、HDL及MHR比较差异均有统计学意义(均P<0.05)。血糖升高、低GCS评分、MHR升高均是aSAH患者预后不良的独立危险因素(均P<0.05)。ROC曲线分析显示,MHR预测aSAH患者预后不良的AUC为0.821,灵敏度为0.625,特异度为0.952,最佳截断值为0.507。结论MHR对aSAH患者预后有较好预测效能,其升高是aSAH患者预后不良的危险因素。

Objective To explore the prognostic value of monocyte to high-density lipoprotein ratio(MHR)for patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 87 patients with aSAH admitted to the Department of Neurosurgery of Jiaxing Second Hospital from January 2020 to December 2022 were enrolled.The diagnosis of aSAH was confirmed by head CT scan and cerebrovascular angiography in all patients,and corresponding intervention was given.Blood samples were collected within 24 h of the onset of the disease,and blood routine test and biochemical analysis were performed.The modified Rankin scale was used to assess the prognosis of patients in 3 months after discharge;and the correlation between MHR and prognosis was analyzed.Results There were 24 patients with poor prognosis and 63 patients with good prognosis.There were no significant differences in gender,smoking history,drinking history,past history,treatment style,CRP,lymphocyte count,TC,albumin and creatinine between patients with poor prognosis and those with good prognosis(all P>0.05),and there were statistically significant differences in age,H-H grade,GCS score,TG,blood glucose,neutrophil count,monocyte count,HDL and MHR(all P<0.05).Multivariate logistic regression analysis showed that MHR was an independent predictor of poor prognosis in aSAH patients(P<0.05).The area under ROC curve(AUC)of MHR in predicting poor prognosis was 0.821,with the cut-off value of 0.507,the sensitivity was 62.5%and the specificity was 95.2%.Conclusion MHR is increased in aSAH patients with poor prognosis,which may be used to predict the prognosis of aSAH patients.