血中性粒细胞/淋巴细胞比值对急性脑出血患者临床预后的预测价值

doi:10.3969/j.issn.1002-1949.2018.12.009

摘要
图/表
参考文献(20)
相关文章 (4)

全文: PDF (657 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的评估中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）对急性脑出血患者临床预后的预测价值。方法将2016-06～2017-12收住南京大学医学院附属鼓楼医院急诊科172例急性脑出血患者，依据发病30 d时格拉斯哥预后评分（Glasgow outcome scale, GOS）分为预后良好组（GOS>3, n=97）和预后不良组（GOS ≤3, n=75）。单因素分析两组患者临床资料，多因素Logistic回归分析明确脑出血患者预后不良的高危因素。Spearman分析探讨NLR与美国国立卫生研究院卒中量表评分(national institute of health stroke scale, NIHSS)和脑出血评分之间的相关性。进一步利用受试者工作特征曲线（receiver operating characteristic curve, ROC）评估NLR对患者早期临床预后的预测价值。结果急性脑出血患者平均年龄（62.95±13.51）岁，男性114例，女性58例。其中预后不良组患者的住院时间较预后良好组明显延长［（18.48±8.25) d vs.(14.94±5.01) d，P=0.002］。共12例患者死亡，病死率6.97%。多因素Logistic回归分析显示, NLR是急性脑出血患者预后不良的危险因素（OR 1.331, 95%CI1.049～1.689, P=0.019）。NLR与NIHSS（Spearman rho 0.499，P< 0.001）及脑出血评分（Spearman rho 0.510，P< 0.001）呈中等强度正相关。NLR预测效能的ROC曲线下面积为0.825 （95%CI0.762～0.886，P=0.000），最佳截断值为4.30（敏感度85.33%, 特异度64.95%；阳性预测值 65.31%, 阴性预测值85.14%；阳性似然比 2.43,阴性似然比0.23）。结论入院时NLR增高是急性脑出血患者预后不良的高危因素，其与NIHSS评分和脑出血评分具有良好的相关性，并且对急性脑出血患者临床预后具有良好的预测价值。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	蒋敏
	顾双双
	蔡楠
	刘瑶
	张秋灵
	王军
	何飞

关键词 ：急性脑出血, 中性粒细胞/淋巴细胞比值（NLR）, 临床预后, 预测效能

基金资助:中央高校基本科研业务费专项资金资助（YG1805059 021414380419）；南京市医学科技发展资金资助“十三五卫生青年人才培养工程”项目(QRX17124); 南京市医学科技发展专项资金资助项目（YKK16074）

通讯作者: 何飞（1981-），男，博士，主治医师，E-mail: hefei1201@163.com。

作者简介: 蒋敏（1988-），女，硕士，住院医师。

引用本文:

蒋敏，顾双双，蔡楠，刘瑶，张秋灵，王军，何飞. 血中性粒细胞/淋巴细胞比值对急性脑出血患者临床预后的预测价值[J]. 中国急救医学, 2018, 38(12): 1057-1061.
Jiang Min, Gu Shuang-shuang, Cai Nan, Liu Yao, Zhang Qiu-ling, Wang Jun, He Fei. Predictive value of the neutrophil-to-lymphocyte ratio in the clinical prognosis of patients with acute intracerebral hemorrhage. Chinese Journal of Critical Care Medicine, 2018, 38(12): 1057-1061.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.12.009 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I12/1057

［1］Ikram MA, Wieberdink RG, Koudstaal PJ. International epidemiology of intracerebral hemorrhage［J］. Curr Atheroscler Rep, 2012, 14(4): 300-306.  ［2］Hansen BM, Nilsson OG, Anderson H, et al. Long term (13 years) prognosis after primary intracerebral haemorrhage: a prospective population based study of long term mortality, prognostic factors and causes of death［J］. J Neurol Neurosurg Psychiatry, 2013, 84(10):1150-1155.  ［3］van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis［J］. Lancet Neurol, 2010, 9(2):167-176.  ［4］Boehme AK, Comeau ME, Langefeld CD, et al. Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage［J］. Neurol Neuroimmunol Neuroinflamm, 2017, 5(2):e428.  ［5］Behrouz R. Re-exploring Tumor Necrosis Factor Alpha as a Target for Therapy in Intracerebral Hemorrhage［J］. Transl Stroke Res, 2016, 7(2):93-96. ［6］Tapia-Pérez JH, Karagianis D, Zilke R, et al. Assessment of systemic cellular inflammatory response after spontaneous intracerebral hemorrhage［J］. Clin Neurol Neurosurg, 2016, 150:72-79.  ［7］Zhou Y, Wei Q, Fan J, et al. Prognostic role of the neutrophil-to-lymphocyte ratio in pancreatic cancer: A meta-analysis containing 8252 patients［J］. Clin Chim Acta, 2018, 479:181-189. ［8］Zhang J, Ren Q, Song Y, et al. Prognostic role of neutrophil-lymphocyte ratio in patients with acute ischemic stroke［J］. Medicine (Baltimore), 2017, 96(45):e8624. ［9］Xu N, Tang XF, Yao Y, et al. Predictive value of neutrophil to lymphocyte ratio in long-term outcomes of left main and/or three-vessel disease in patients with acute myocardial infarction［J］. Catheter Cardiovasc Interv, 2018, 91(S1):551-557. ［10］Sun Y, You S, Zhong C, et al. Neutrophil to lymphocyte ratio and the hematoma volume and stroke severity in acute intracerebral hemorrhage patients［J］. Am J Emerg Med, 2017, 35(3):429-433. ［11］Lattanzi S, Cagnetti C, Provinciali L, et al. Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage［J］. Stroke, 2016, 47(6):1654-1657. ［12］中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014)［J］. 中华神经科杂志, 2015, 48(6):435-444. ［13］Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes［J］. Stroke, 1996, 27(8):1304-1305. ［14］姜雅菲, 陈志浩, 赖华生, 等. 粒细胞/淋巴细胞比率在幕上自发性脑出血诊断中的价值［J］. 广东医学, 2016, 37(22):3376-3380.［15］Chu SY, Hwang DY. Predicting outcome for intracerebral hemorrhage patients: current tools and their limitations［J］. Semin Neurol, 2016, 36(3):254-260.  ［16］Aronowski J, Zhao X. Molecular pathophysiology of cerebral hemorrhage: Secondary brain injury［J］. Stroke, 2011, 42(6):1781-1786. ［17］Lattanzi S, Cagnetti C, Rinaldi C, et al. Neutrophil-to-lymphocyte ratio improves outcome prediction of acute intracerebral hemorrhage［J］. J Neurol Sci, 2018, 387:98-102.  ［18］Wang F, Hu S, Ding Y, et al. Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral Hemorrhage［J］. J Stroke Cerebrovasc Dis, 2016, 25(1):182-187.  ［19］Ye Z, Ai X, Fang F, et al. The use of neutrophil to lymphocyte ratio as a predictor for clinical outcomes in spontaneous intracerebral hemorrhage［J］. Oncotarget, 2017, 8(52):90 380-90 389.  ［20］Nakagawa K, King SL, Seto TB. Optimal hematoma volume cut points to predict functional outcome after basal ganglia and thalamic hemorrhages［J］. Front Neurol, 2018,9:291.