NLR和AFR与动脉瘤性蛛网膜下腔出血患者迟发性脑缺血的关系研究  

Neutrophil to lymphocyte ratio(NLR)and albumin to fibrinogen ratio(AFR)in prediction of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

作　　者：陈素云[1] 赵志新[2] 杨仙鸿 胡小铭[2] 陈世勇[1] CHEN Suyun;ZHAO Zhixin;YANG Xianhong;HU Xiaoming;CHEN Shiyong(Clinical Laboratory,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China)

机构地区：[1]浙江省台州医院检验科,317000 [2]浙江省台州医院神经外科,317000

出　　处：《浙江医学》2020年第14期1485-1488,共4页Zhejiang Medical Journal

基　　金：浙江省公益技术应用研究(LGF19H090014)。

摘　　要：目的探讨中性淋巴细胞比率(NLR)和白蛋白(Alb)/Fib(AFR)对动脉瘤性蛛网膜下腔出血(aSAH)患者迟发性脑缺血(DCI)的预测价值。方法选取2012年1月至2017年12月浙江省台州医院院收治的a SAH患者170例,根据发生DCI的情况,将患者分为DCI组52例与无DCI组118例,比较两组患者的临床资料和实验室指标,评估NLR和AFR对a SAH患者DCI的诊断效能,分析影响a SAH患者预后的因素,评估NLR-AFR评分对a SAH后DCI的预测价值。结果DCI组的年龄、Hunt-Hess分级III-V/I-II、WBC、中性粒细胞计数、NLR、Fib水平均高于无DCI组(均P<0.05),而格拉斯哥昏迷指数(GCS)评分、Alb水平、AFR均低于无DCI组(均P<0.05)。NLR对a SAH后DCI诊断的AUC为0.702,灵敏度为0.71,特异度为0.61;AFR对a SAH后DCI诊断的AUC为0.725,灵敏度为0.73,特异度为0.60。多因素logistic回归分析显示GCS评分(OR=0.797,95%CI:0.674~0.943,P<0.05)、Hunt-Hess分级≥III(OR=3.225,95%CI:1.053~9.874,P<0.05)、NLR>9.65(OR=3.743,95%CI:1.498~9.352,P<0.05)、AFR>11.20(OR=0.320,95%CI:0.132~0.777,P<0.05)是a SAH患者发生DCI的影响因素。ROC曲线显示NLR-AFR评分预测a SAH后DCI的AUC为0.796(95%CI:0.720~0.871,P<0.05)。结论外周血NLR升高、AFR降低是影响a SAH患者DCI的独立危险因素。NLR-AFR评分可作为诊断a SAH后DCI的良好指标。Objective To analyze the predictive value of neutrophil to lymphocyte ratio(NLR)and albumin to fibrinogen ratio(AFR)for delayed cerebral ischemia(DCI)in patients with aneurysmal subarachnoid hemorrhage.Methods One hundred and seventy patients with aneurysmal subarachnoid hemorrhage(aSAH)who underwent surgical treatment in Taizhou Hospital of Zhejiang Province between 2012 and 2017 were enrolled in the study,among whom 52 cases complicated with DCI(DCI group),and 118 cases were excluded from DCI complication(non-DCI group).The clinical data and laboratory findings of the two groups were compared.The risk factors of DCI in a SAH patients were analyzed.The efficacy of NLR and AFR in diagnosis of DCI in SSAH patients was evaluated.The predictive value of the NLR-AFR score for DCI in a SAH patients was evaluated.Results The age,hunt-Hess grade III-V/I-II,white blood cell(WBC)count,neutrophil count,NLR,fibrinogen(Fib)in DCI group were significantly higher;while the GCS score,albumin levels and AFR were significantly lower than those in non-DCI group(all P<0.05).The area under the curve(AUC)of NLR for diagnosis of DCI was 0.702 with a sensitivity of 0.71 and specificity of 0.61.The AUC of AFR for diagnosis of DCI was 0.725 with a sensitivity of 0.73 and specificity of 0.60.Multivariate logistic regression analysis showed that GCS score(OR=0.797,95%CI:0.674~0.943,P<0.05),Hunt-Hess grade≥Ⅲ(OR=3.225,95%CI:1.053~9.874,P<0.05),NLR>9.65(OR=3.743,95%CI:1.498~9.352,P<0.05),AFR>11.20(OR=0.320,95%CI:0.132~0.777,P<0.05)were the independent risk factors for DCI in a SAH patients.The ROC curve showed that the AUC of NLR-AFR score for predicting DCI in patients with a SAH was 0.79(95%CI:0.720~0.871,P<0.05).Conclusion The increasd NLR and decreased AFR are independent risk factors for DCI in the patients with a SAH.NLR-AFR score is a good indicator of DCI in a SAH patients.

关 键 词：白蛋白/纤维蛋白原 中性淋巴细胞比率 动脉瘤性蛛网膜下腔出血 迟发性脑缺血 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R743.31[医药卫生—临床医学]