中性粒细胞与淋巴细胞比率联合ICH评分预测自发性脑出血患者30 d转归  

Neutrophil to lymphocyte ratio combined with ICH score predicts 30-day outcomes in patients with spontaneous cerebral hemorrhage

作　　者：岳宏[1] 武爱梅 陈静 田玉蓉 黄芳 吴君仓[1] Yue Hong;Wu Aimei;Chen Jing;Tian Yurong;Huang Fang;Wu Juncang(Department of Neurology,the Second People's Hospital of Hefei,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院神经内科,230011

出　　处：《国际脑血管病杂志》2020年第3期175-179,共5页International Journal of Cerebrovascular Diseases

基　　金：合肥市自主创新政策"借转补"项目(J2019Y01);安徽医科大学校科研基金项目(2019xkj191)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比率(neutrophil-to-lymphocyte ratio,NLR)与自发性脑出血患者30 d临床转归的相关性,以及将NLR加入ICH评分能否提高预测转归不良的准确性。方法回顾性纳入2018年3月至2019年4月在安徽医科大学附属合肥医院住院的自发性脑出血患者,记录人口统计学以及基线临床和影像学资料,在发病24 h内获得中性粒细胞绝对计数和淋巴细胞绝对计数并计算NLR。在脑出血发病后30 d时采用改良Rankin量表进行转归评价,≤2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归分析确定转归不良的独立危险因素。采用受试者工作特征曲线评价基线NLR、ICH评分及NLR+ICH评分对自发性脑出血患者转归不良的预测价值。结果共纳入159例自发性脑出血患者,男性106例(66.67%),年龄(62.29±15.10)岁;中性粒细胞计数(7.30±3.95)×10^9/L,淋巴细胞计数(1.41±0.67)×10^9/L,NLR(6.94±7.66);基线血肿体积(17.93±25.87)ml,ICH评分中位数0分(四分位数间距0~1分)。30 d时60例患者(37.7%)转归不良。单变量分析显示,转归不良组患者冠心病、收缩压、舒张压、超敏C反应蛋白、空腹血糖、白细胞计数、中性粒细胞计数、NLR、血肿破入脑室、血肿体积、NIHSS评分以及ICH评分均显著高于转归良好组(P均<0.05)。多变量logistic回归分析显示,NLR是急性自发性脑出血患者发病后30 d转归不良的独立预测因素(优势比1.135,95%可信区间1.092~2.321;P=0.038)。受试者工作特征曲线分析显示,NLR最佳截断值为6.679,预测转归不良的敏感性和特异性分别为51.67%和76.77%;ICH评分最佳截断值为1.0分,预测转归不良的敏感性和特异性分别为69.71%和89.80%;联合应用NLR+ICH评分预测转归不良的敏感性和特异性分别为74.58%和82.65%。结论NLR与自发性脑出血发病后30 d转归不良独立相关,加入ICH评分能提高预测转归不良的准确性。Objective To investigate the correlation between neutrophil to lymphocyte ratio(NLR)and 30-day clinical outcomes in patients with spontaneous cerebral hemorrhage and whether adding NLR to ICH score improve the accuracy of predicting poor outcomes.Methods Patients with spontaneous intracerebral hemorrhage admitted to the Department of Neurology,the Second People's Hospital of Hefei from March 2018 to April 2019 were enrolled retrospectively.The demographic and baseline clinical and imaging data were documented.The absolute neutrophil counts and absolute lymphocyte counts within 24 h of onset were obtained and NLR was calculated.At 30 d after the onset of cerebral hemorrhage,the modified Rankin Scale was used to evaluate the outcomes.Good outcome was defined as≤2,and poor outcome was defined as>2.Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of baseline NLR,ICH score and NLR+ICH score for poor outcomes in patients with spontaneous cerebral hemorrhage.Results A total of 159 patients with spontaneous cerebral hemorrhage were enrolled,including 106 males(66.67%),age 62.29±15.10 years.Neutrophil count was(7.30±3.95)×10^9/L,lymphocyte count was(1.41±0.67)×10^9/L,and NLR was 6.94±7.66.Baseline hematoma volume was 17.93±25.87 ml,median ICH score 0(interquartile range 0-1).The outcomes of 60 patients(37.7%)were poor at 30 d.Univariate analysis showed that coronary heart disease,systolic blood pressure,diastolic blood pressure,high-sensitivity C-reactive protein,fasting blood glucose,white blood cell count,neutrophil count,NLR,hematoma broken into the ventricle,hematoma volume,NIHSS and ICH scores in the poor outcome group were significantly higher than those of the good outcome group(all P<0.05).Multivariate logistic regression analysis showed that NLR was an independent predictor of poor outcomes at 30 d after the onset of spontaneous cerebral hemorrhage(odds r

关 键 词：脑出血 中性粒细胞 淋巴细胞 疾病严重程度指数 治疗结果 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]