血液检测值及中性粒细胞/淋巴细胞比对首发缺血性脑卒中患者住院费用预测作用  

Predictive effect of blood test value and neutral/lymphocyte ratio on hospitalization cost among first-ever ischemic stroke patients

作　　者：杨新雷 伍鸿鹄 易云[1] 周伟[2] 许源 易应萍[3] 张焱[4] YANG Xin-lei;WU Hong-hu;YI Yun(Biobank Center,The Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi Province 330006,China;不详)

机构地区：[1]南昌大学第二附属医院生物样本资源中心,江西南昌330006 [2]南昌大学第二附属医院心内科 [3]南昌大学第二附属医院医疗大数据中心 [4]南昌大学第二附属医院科技处

出　　处：《中国公共卫生》2021年第4期741-745,共5页Chinese Journal of Public Health

基　　金：国家重点研发计划(2018YFC1312902);江西省科技厅科技创新平台(20171BCD40024);江西省科技厅重大项目(20171BBH80025)。

摘　　要：目的了解血液检测值及中性粒细胞/淋巴细胞比(NLR)对首发缺血性脑卒中患者住院费用的预测作用,为提升有限医疗资源的利用提供参考依据。方法收集2009年1月—2017年7月南昌大学第二附属医院收治的5340例≥18岁首发缺血性脑卒中患者的临床资料,分析入院24 h内的血液检测值及NLR对住院费用的预测作用。结果首发缺血性脑卒中患者的平均住院费用为(17607.75±15088.15)元,中位数住院费用为13530.87元;多因素非条件logistic回归分析结果显示,医保患者及糖化血红蛋白(HbA1c)、总胆红素(TBIL)、葡萄糖(Glu)、总胆固醇(TC)、肌酐(Cre)和NLR较高均为首发缺血性脑卒中患者住院费用的独立危险因素;NLR预测的受试者工作特征曲线(ROC)曲线下面积(AUC)为0.630(95%CI=0.615~0.645),NLR结合HbA1c、TBIL、Glu、TC、Cre预测的AUC为0.665(95%CI=0.650~0.679),NLR的预测临界值为3.30。结论首发缺血性脑卒中患者HbA1c、TBIL、Glu、TC、Cre和NLR与住院费用关系密切,有一定预测价值。Objective To evaluate predictive effect of blood tests and neutral/lymphocyte ratio(NRL) on hospitalization cost among first-ever ischemic stroke patients for providing evidences to promote effective utilization of medical resources.Methods Clinical and other relevant data on 5 840 adult patients(≥ 18 years) with first-ever ischemic stroke admitted to a general hospital in Nanchang city of Jiangxi province from January 2009 through July 2017 were collected and associations of blood test values and NRL within 24 hours of the admission with hospitalization cost were analyzed. Results Of all the inpatients averagely aged 65.22 ± 12.24 years, 3 351(62.75%) were males. The median of the hospitalization cost for all the inpatients was 13 530.87 RMB yuan. Unconditional multivariate regression analysis revealed following significant independent risk factors for hospitalization cost: medical insurance(odds ratio [OR] = 1.368), haemoglobin A1 c(HbA1 c,OR = 1.082), total bilirubin(TBIL, OR = 1.027), glucose(Glu, OR = 1.068), total cholesterol(TC, OR = 1.066), creatinine(Cre, OR = 1.002), and NLR(OR = 1.488)(P < 0.05 for all). The receiver operator characteristic curve(ROC) analysis demonstrated that the border value of NLR was 3.30, which was a good predictor for hospitalization cost. The combined prediction result of NLR, HbA1 c, TBIL, CHOL, Cre, and Glu was better than that of each single factor, with an area under the curve(AUC) of 0.665(95% confidence interval: 0.650–0.679), indicating a good prediction effect.Conclusion Glycosylated hemoglobin, total bilirubin, glucose, total cholesterol, creatinine, and neutral/lymphocyte ratio are closely related to hospitalization cost among the first-ever ischemic stroke patients and, to some extent, these blood test indicators could be adopted to predicate hospitalization cost of the inpatients.

关 键 词：缺血性脑卒中 首发 住院费用 血液检测值 中性粒细胞/淋巴细胞比(NLR) 预测作用 

分 类 号：R743.3[医药卫生—神经病学与精神病学]