术前血清中性粒细胞-淋巴细胞比值对动脉瘤性蛛网膜下隙出血术后行气管切开的预测价值  

Predictive Value of Preoperative Serum Neutrophil-to-Lymphocyte Ratio in Predicting Postoperative Tracheostomy of Patients with Aneurysmal Subarachnoid Hemorrhage

作　　者：叶景 李业海 林建浩 黄佛宝 何桂录 刘泽斯 张良 YE Jing;LI Yehai;LIN Jianhao;HUANG Fobao;HE Guilu;LIU Zesi;ZHANG Liang(Department of Neurosurgery 1, Guang Dong 999 Brain Hospital (Brain Hospital Affiliated to Ji'nan University), Guangzhou 510510, China)

机构地区：[1]广东三九脑科医院(暨南大学附属脑科医院)神经外一科,广州510510

出　　处：《福建医科大学学报》2022年第1期37-41,60,共6页Journal of Fujian Medical University

基　　金：广州市科技计划项目(202002030309)。

摘　　要：目的探讨术前血清中性粒细胞-淋巴细胞比值(NLR)对动脉瘤性蛛网膜下隙出血(aSAH)患者术后行气管切开的预测价值。方法收集2013年1月—2021年1月385例就诊笔者单位行脑动脉瘤手术的患者的临床特征、实验室指标、影像学指标等资料。根据术后是否行气管切开将患者分为气切组与未气切组。单因素和多因素logistic回归分析NLR与aSAH患者术后气管切开的相关性。受试者工作曲线(ROC)和Delong检验研究NLR的预测性能。结果气切组NLR水平高于未气切组[16.04(11.39~19.97)vs 6.95(4.11~11.19),P<0.001]。单因素和多因素logistic回归分析发现,NLR(OR=1.09;95%CI:1.02~1.16;P=0.013)是术后气管切开的独立预测因素。ROC曲线发现,NLR预测气切组患者的曲线下面积为0.824(95%CI:0.782~0.861),最佳界值为11.03,敏感性为83.33%,特异性为74.79%,约登指数为0.581。Delong检验发现,与其他3个独立预测因素比较,NLR预测的准确性较世界神经外科联盟(WFNS)分级量表分级差(Z=3.182,P=0.002),但优于年龄(Z=2.905,P=0.004)和动脉瘤位置(Z=4.016,P<0.001)。结论术前血清NLR对预测aSAH患者术后行气管切开具有一定的指导价值。Objective To investigate the predictive value of preoperative serum neutrophil-to-lymphocyte ratio(NLR)in predicting postoperative tracheostomy in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 385 patients admitted in our institution for aSAH surgery from January 2013 to January 2021 was included in this retrospective study.The clinical,laboratory,and radiographic data were collected.Univariate and multivariate logistic regression analysis were used to evaluate the association between NLR and postoperative tracheostomy.The receiver operating characteristic curve(ROC)analysis and Delong test were used to determine the predictive value of NLR.Results The level of NLR in postoperative tracheostomy group was significantly higher than those non-postoperative-tracheostomy group[16.04(11.39-19.97)vs 6.95(4.11-11.19),P<0.001].Univariate and multivariate logistic regression analysis showed that preoperative serum NLR(OR=1.09,95%CI:1.02-1.16,P=0.013)was independent predictive factor of postoperative tracheostomy.The ROC analysis showed that the area under the curve,optimal cutoff value,sensitivity,specificity and Youden index of NLR in predicting patients in postoperative tracheostomy group were 0.824(95%CI:0.782-0.861),11.03,83.33%,74.79%and 0.581.Delong test showed that the predictive value of NLR was worse than World Federation of Neurosurgical Societies(WFNS)grade(Z=3.182,P=0.002)and better than age(Z=2.905,P=0.004)and aneurysm location(Z=4.016,P<0.001).Conclusion Preoperative serum NLR has certain application value in predicting postoperative tracheostomy in aSAH patients.

关 键 词：动脉瘤性蛛网膜下隙出血 中性粒细胞-淋巴细胞比值 气管切开 

分 类 号：R73[医药卫生—肿瘤]