全身炎症反应相关指标与脑出血严重程度的关系及其对预后的预测价值  

Relationship between indicators related to systemic inflammatory response and severity of intracerebral hemorrhage and their predictive value for prognosis

作　　者：孙嵩 金鑫[2] 顾靖宇 尹子乾 孙亮[2] 虞正权[2] 吴江[2] SUN Song;JIN Xin;GU Jinyu;YIN Ziqian;SUN Liang;YU Zhengquan;WU Jiang(Department of Neurosurgery,Guanyun People's Hospital,Lianyungang 222200,China)

机构地区：[1]灌云县人民医院神经外科,连云港222200 [2]苏州大学附属第一医院神经外科

出　　处：《临床神经外科杂志》2024年第6期683-688,693,共7页Journal of Clinical Neurosurgery

基　　金：江苏省科技计划专项资金资助项目(BE2023712);苏州市卫生健康委员会医疗卫生科技创新基金资助项目(SKY2022002)。

摘　　要：目的 探讨外周血白细胞计数(WBC)、中性粒细胞计数(ANC)、淋巴细胞计数(ALC),CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞数,以及肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白介素-6(IL-6)、转化生长因子-β1(TGF-β1)与急性脑出血(ICH)患者病情严重程度的关系及其对预后的预测价值。方法 选取2020年1月—2021年6月灌云县人民医院神经外科收治住院的65例自发性ICH患者为观察组,选取27例同期健康体检者作为对照组。检测外周血中各类型淋巴细胞数百分比及血清中相关炎症因子(TNF-α、CRP、IL-6、TGF-β1)含量,分析其动态变化趋势及其与ICH严重程度的相关性。使用Cox比例风险模型及受试者工作特征(ROC)曲线分析炎症反应相关指标对ICH患者预后的预测效能。结果 中型和重型患者WBC、ALC、CD3^(+)T淋巴细胞显著下降;ICH患者CRP、TNF-α及IL-6含量升高,TGF-β1含量降低;出血后第1、3、7天患者WBC、ALC、CRP、TNF-α及IL-6含量升高,CD3^(+)、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)比值及TGF-β1含量降低;第14天ICH患者WBC、ALC均明显高于对照组;ICH无好转组患者WBC、ALC、CRP、TNF-α及IL-6含量升高,CD3^(+)、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)比值及TGF-β1含量降低;好转组患者WBC、ALC、TNF-α及IL-6含量升高,CD3^(+)、TGF-β1含量降低;CD3^(+)、CD4^(+)、CD8^(+)DCA综合分析模型的净收益优于其他3个模型;时间依赖的曲线下面积(AUC)分析表明WBC的预测性能最优,且WBC、ALC、CRP、TNF-α为预后的危险因素。结论 WBC、ALC、CRP、IL-6及TNF-α在ICH患者中呈明显升高,且与病情严重程度呈正相关,可作为判定病情严重程度的重要指标,且WBC在预测ICH患者预后中更具有重要意义。Objective To investigate the relationship of peripheral blood white blood cell count(WBC),neutrophil count(ANC),lymphocyte count(ALC),CD3^(+),CD4^(+),CD8^(+)T-lymphocyte counts,as well as tumor necrosis factor-alpha(TNF-alpha),C-reactive protein(CRP),interleukin-6(IL-6),transforming growth factor-beta 1(TGF-β1)and the severity of acute intracerebral hemorrhage(ICH).To explore their predictive value for prognosis.Methods Sixty-five patients with spontaneous ICH who were admitted to Department of Neurosurgery,Guanyun People s Hospital from January 2020 to June 2021 were selected as the observation group,and 27 healthy people who underwent physical examination during the same period were selected as the control group.The percentages of various types of lymphocytes in peripheral blood and the levels of related inflammatory factors(TNF-α,CRP,IL-6,TGF-β1)in serum were detected,and their dynamic change trends and their correlation with the severity of ICH were analyzed.The Cox proportional hazard model and receiver operating characteristic(ROC)curve were used to analyze the predictive performance of inflammatory response-related indicators on the prognosis of patients with ICH.Results WBC,ALC,and CD3^(+)lymphocytes were significantly decreased in medium and heavy patients compared with the control group.The serum levels of each immune factor in light,medium and severe patients were elevated in CRP,TNF-α,and IL-6,and decreased in TGF-β1,compared with the regular group.In patients on days 1,3,and 7 after hemorrhage,WBC,ALC,CRP,TNF-α,and IL-6 WBC,ALC,CRP,TNF-αand IL-6 were increased,while CD3^(+),CD4^(+)T lymphocytes,CD4^(+)/CD8^(+)ratio and TGF-β1 were decreased in patients with ICH.On the 14th day,the WBC and ALC levels in patients with ICH were significantly higher than those in the control group.In the group with no improvement in ICH,the WBC,ALC,CRP,TNF-αand IL-6 were increased.CD3^(+),CD4^(+)T lymphocytes,while CD4^(+)/CD8^(+)ratio and TGF-β1 were decreased.The levels of WBC,ALC,TNF-α,and IL-6 increased in

关 键 词：脑出血 全身炎症反应 预测价值 

分 类 号：R743[医药卫生—神经病学与精神病学]