多种炎症标志物对脑出血不良预后预测能力的比较研究  

Comparative study on the predictive abilities of multiple inflammatory markers for the poor outcome of intracerebral hemorrhage

作　　者：黄琴[1] 宋紫薇 况洪腊 张治 朱玉萍 吴麟[2] 洪道俊[1] 林晶 朱敏[1] HUANG Qin;SONG Ziwei;KUANG Hongla;ZHANG Zhi;ZHU Yuping;WU Lin;HONG Daojun;LIN Jing;ZHU Min(Department of Neurology,The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院神经内科,南昌330006 [2]南昌大学第一附属医院影像科

出　　处：《中国神经精神疾病杂志》2025年第2期103-108,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探究脑出血患者多种炎症标志物与预后的关系,并比较多种炎症标志物的预测能力。方法回顾性分析2015年1月1日至2023年3月31日在南昌大学第一附属医院神经内科收治的脑出血患者,根据脑出血后90 d的改良Rankin量表(modified Rankin scale,mRS)评分,将其分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分≥3分)。比较两组的一般信息、检验、检查和随访资料,其中炎症标志物包括中性粒细胞与淋巴细胞比(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比(platelet to lymphocyte ratio,PLR)、单核细胞与高密度脂蛋白比(monocyte to high-density lipoprotein ratio,MHR)、系统性炎症反应指数(systemic inflammatory response index,SIRI)、全身免疫炎症指数(systemic immune-inflammation index,SII)、白细胞计数与平均血小板体积比(white blood cell count to mean platelet volume ratio,WMR)、淋巴细胞与单核细胞比(lymphocyte to monocyte ratio,LMR)、全身凝血炎症指数(systemic coagulation-inflammation index,SCI)。采用单因素及多因素逻辑回归分析方法分析脑出血后不良预后的预测因子,并构建受试者操作特征(receiver operating characteristic,ROC)曲线来比较其预测能力。结果本研究总共入组510例脑出血患者,其中预后良好组297例(58.2%),预后不良组213例(41.8%)。基线资料的比对显示与预后良好的患者相比,预后不良的患者在入院时具有更高水平的白细胞、中性粒细胞、高密度脂蛋白、纤维蛋白原、NLR、PLR、SIRI、SII、WMR;基线血肿体积和基线水肿体积较大,脑叶出血比例更高,年龄更大,更低水平的血小板、淋巴细胞、LMR和SCI,差异均有统计学意义(P<0.05)。多元logistic回归结果显示NLR(OR:1.081,95%CI:1.032~1.1131,P=0.001)、SIRI(OR:1.089,95%CI:1.014~1.169,P=0.019)、SII(OR:1.000,95%CI:1.000~1.001,P=0.011)、WMR(OR:2.627,95%CI:1.267~5.445,P=0.009)为脑出血后患者预后不良的独立危险因素。Objective This study aimed to investigate the relationship between multiple inflammatory markers and poor outcome in patients with intracerebral hemorrhage,and to compare their predictive abilities.Methods We retrospectively analyzed the patients with intracerebral hemorrhage admitted to the Department of Neurology of the First Affiliated Hospital of Nanchang University from January 1,2015 to March 31,2023.According to the Modified Rankin Scale at 90 days after onset,the patients were divided into good outcome(mRS≤2 points)and poor outcome(mRS score≥3 points).Clinical information,laboratory examinations and follow-up data were compared between the two groups.Inflammatory markers include neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to high density lipoprotein ratio(MHR),systemic inflammatory response index(SIRI),systemic immune-inflammation index(SII),white blood cell count to mean platelet volume ratio(WMR),lymphocyte to monocyte ratio(LMR),and systemic coagulation-inflammation index(SCI).Univariate and multivariate logistic regression analysis were used to analyze the predictors of poor prognosis after intracerebral hemorrhage,and receiver operating characteristic curve(ROC)was constructed to compare their predictive ability.Results A total of 510 patients with intracerebral hemorrhage were included.Of those,297(58.2%)had good outcome,and 213(41.8%)had poor outcome.Comparison of baseline characteristics demonstrated that patients with poor prognosis had higher levels of white blood cells,neutrophils,high density lipoprotein,fibrinogen,NLR,PLR,SIRI,SII,WMR at admission,larger baseline hematoma volume and baseline perihematomal edema volume,a higher proportion of lobar hemorrhage,older age,and lower levels of platelets,lymphocytes,LMR,and SCI(P<0.05).Multivariate regression analysis showed that NLR(OR:1.081,95%CI:1.032~1.1131,P=0.001),SIRI(OR:1.089,95%CI:1.014~1.169,P=0.019),SII(OR:1.000,95%CI:1.000~1.001,P=0.011),WMR(OR:2.627,95%CI:1.267~5.445,P=0.009)were independently assoc

关 键 词：脑出血 预后不良 炎症标记物 预测能力 中性粒细胞与淋巴细胞比值 系统性炎症反应指数全身免疫炎症指数 白细胞计数与平均血小板体积比 

分 类 号：R743[医药卫生—神经病学与精神病学]