中性粒细胞与淋巴细胞比值与自发性脑出血后神经功能恶化的关系
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摘要
目的探讨自发性脑出血(ICH)后神经功能恶化(ND)的影响因素,分析中性粒细胞与淋巴细胞比值(NLR)与ND的关系。方法回顾性分析2016年1月至2018年1月在哈励逊国际和平医院住院的ICH患者130例,其中1周内发生ND 37例(观察组),未发生ND 93例(对照组)。收集2组患者就诊时的一般资料、头颅CT成像数据和入院血常规指标[白细胞计数(WBC)、中性粒细胞绝对值(ANC)、淋巴细胞绝对值(ALC)和NLR]数据,应用Logistic回归模型分析ND的影响因素;绘制受试者工作特征曲线分析各指标对ND的预测价值。结果观察组美国国立卫生研究院卒中量表评分和脑出血量均高于对照组,差异均有统计学意义(均P<0.05)。观察组入院时WBC、ANC和NLR水平均高于对照组[(11±4)×10~9/L比(9±4)×10~9/L,(10±5)×10~9/L比(6±3)×10~9/L,(9.7±5.6)比(4.1±2.6)],ALC水平低于对照组[(1.8±0.8)×10~9/L比(2.1±1.9)×10~9/L],差异均有统计学意义(P=0.011、<0.001、<0.001、0.019)。Logistic回归分析结果显示校正年龄、性别、美国国立卫生研究院卒中量表评分、脑出血量、脑出血部位、是否存在脑室出血、收缩期和舒张期血压变异系数等因素后,WBC(比值比=1.27,95%置信区间:1.10～1.48,P=0.032)、ANC(比值比=1.59,95%置信区间:1.28～1.98,P=0.034)、ALC(比值比=0.19,95%置信区间:0.07～0.51,P=0.033)和NLR(比值比=1.55,95%置信区间:1.29～2.02,P=0.012)仍为ND的影响因素。NLR预测ICH患者1周内ND的受试者工作特征曲线下面积大于WBC、ANC和ALC(0.878比0.699、0.754、0.819),最佳临界值为5.66。结论 NLR可预测ICH后ND,有助于对患者进行危险分层。
Objective To investigate the influence factors of neurological damage(ND)after spontaneous intracranial hemorrhage(ICH)and analyze the relation between neutrophil to lymphocyte ratio(NLR)and ND.Methods Clinical data of 130 ICH patients,including 37 cases with ND occurring in 1 week after hemorrhage(observation group)and 93 cases without ND(control group),who were admitted to Harrison International Peace Hospital between January 2016 and January 2018 were analyzed.General information,cranial CT imaging data and blood routine indexes[white blood cell count(WBC),absolute neutrophil count(ANC),absolute lymphocyte count(ALC)and NLR]were analyzed using logistic regression model.Predictive values of the indexes for NDwere analyzed by receiver operating characteristic(ROC)curve.Results Score of National Institutes of Health Stroke Scale(NIHSS)and volume of cerebral hemorrhage in observation group were higher than those in control group(both P<0.05).Levels of WBC,ANC and NLR on admission in observation group were higher than those in control group[(11±4)×10~9/L vs(9±4)×10~9/L,(10±5)×10~9/L vs(6±3)×10~9/L,(9.7±5.6)vs(4.1±2.6)]and ALC level in observation group was lower than that in control group[(1.8±0.8)×10~9/L vs(2.1±1.9)×10~9/L](P=0.011,<0.001,<0.001,0.019).After adjustments of age,gender,score of NIHSS,volume of cerebral hemorrhage,presence of intraventricular hemorrhage,systolic and diastolic blood pressure variation coefficients,logistic regression analysis showed that WBC(ratio=1.27,95%confidence interval:1.10-1.48,P=0.032),ANC(ratio=1.59,95%confidence interval:1.28-1.98,P=0.034),ALC(ratio=0.19,95%confidence interval:0.07-0.51,P=0.033)and NLR(ratio=1.55,95%confidenceinterval:1.29-2.02,P=0.012)were influence factors of ND.Area under ROC curve of NLR in predicting the occurrence of ND was larger than that of WBC,ANC and ALC(0.878 vs 0.699,0.754,0.819)and the optimal cut-off value was 5.66.Conclusion NLR is helpful in the prediction of ND after ICH.
Objective To investigate the influence factors of neurological damage(ND)after spontaneous intracranial hemorrhage(ICH)and analyze the relation between neutrophil to lymphocyte ratio(NLR)and ND.Methods Clinical data of 130 ICH patients,including 37 cases with ND occurring in 1 week after hemorrhage(observation group)and 93 cases without ND(control group),who were admitted to Harrison International Peace Hospital between January 2016 and January 2018 were analyzed.General information,cranial CT imaging data and blood routine indexes[white blood cell count(WBC),absolute neutrophil count(ANC),absolute lymphocyte count(ALC)and NLR]were analyzed using logistic regression model.Predictive values of the indexes for NDwere analyzed by receiver operating characteristic(ROC)curve.Results Score of National Institutes of Health Stroke Scale(NIHSS)and volume of cerebral hemorrhage in observation group were higher than those in control group(both P<0.05).Levels of WBC,ANC and NLR on admission in observation group were higher than those in control group[(11±4)×10~9/L vs(9±4)×10~9/L,(10±5)×10~9/L vs(6±3)×10~9/L,(9.7±5.6)vs(4.1±2.6)]and ALC level in observation group was lower than that in control group[(1.8±0.8)×10~9/L vs(2.1±1.9)×10~9/L](P=0.011,<0.001,<0.001,0.019).After adjustments of age,gender,score of NIHSS,volume of cerebral hemorrhage,presence of intraventricular hemorrhage,systolic and diastolic blood pressure variation coefficients,logistic regression analysis showed that WBC(ratio=1.27,95%confidence interval:1.10-1.48,P=0.032),ANC(ratio=1.59,95%confidence interval:1.28-1.98,P=0.034),ALC(ratio=0.19,95%confidence interval:0.07-0.51,P=0.033)and NLR(ratio=1.55,95%confidenceinterval:1.29-2.02,P=0.012)were influence factors of ND.Area under ROC curve of NLR in predicting the occurrence of ND was larger than that of WBC,ANC and ALC(0.878 vs 0.699,0.754,0.819)and the optimal cut-off value was 5.66.Conclusion NLR is helpful in the prediction of ND after ICH.
引文
[1]施雪英,袁良津,蒋鸣坤,等.自发性脑出血神经功能恶化的相关因素临床分析[J].安徽医药,2018,22(7):1286-1289.DOI:10.3969/j.issn.1009-6469.2018.07.016.Shi XY,Yuan LJ,Jiang MK,et al.Clinical analysis of related factors of neurological deterioration in spontaneous intracerebral hemorrhage[J].Anhui Medical and Pharmaceutical Journal,2018,22(7):1286-1289.DOI:10.3969/j.issn.1009-6469.2018.07.016.
[2]Mayer SA,Sacco RL,Shi T,et al.Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage[J].Neurology,1994,44(8):1379-1384.
[3]Di Napoli M,Godoy DA,Campi V,et al.C-reactive protein in intracerebral hemorrhage:time course,tissue localization,and prognosis[J].Neurology,2012,79(7):690-699.DOI:10.1212/WNL.0b013e318264e3be.
[4]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.DOI:10.1161/STROKEAHA.116.013627.
[5]Inzitari D.The Italian Guidelines for stroke prevention.The Stroke Prevention and Educational Awareness Diffusion(SPREAD)Collaboration[J].Neurol Sci,2000,21(1):5-12.
[6]Lord AS,Gilmore E,Choi HA,et al.Time course and predictors of neurological deterioration after intracerebral hemorrhage[J].Stroke,2015,46(3):647-652.DOI:10.1161/STROKEAHA.114.007704.
[7]Lattanzi S,Cagnetti C,Provinciali L,et al.Blood pressure variability and clinical outcome in patients with acute intracerebralhemorrhage[J].J Stroke Cerebrovasc Dis,2015,24(7):1493-1499.DOI:10.1016/j.jstrokecerebrovasdis.2015.03.014.
[8]Lattanzi S,Silvestrini M.Blood pressure in acute intra-cerebral hemorrhage[J].Ann Transl Med,2016,4(16):320.DOI:10.21037/atm.2016.08.04.
[9]Wityk RJ,Pessin MS,Kaplan RF,et al.Serial assessment of acute stroke using the NIH stroke scale[J].Stroke,1994,25(2):362-365.
[10]Mracsko E,Javidi E,Na SY,et al.Leukocyte invasion of the brain after experimental intracerebral hemorrhage in mice[J].Stroke,2014,45(7):2107-2114.DOI:10.1161/STROKEAHA.114.005801.
[11]Moxon-Emre I,Schlichter LC.Neutrophil depletion reduces bloodbrain barrier breakdown,axon injury,and inflammation afterintracerebral hemorrhage[J].J Neuropathol Exp Neurol,2011,70(3):218-235.DOI:10.1097/NEN.0b013e31820d94a5.
[12]Meisel C,Schwab JM,Prass K,et al.Central nervous system injury-induced immune deficiency syndrome[J].Nat Rev Neurosci,2005,6(10):775-786.DOI:10.1038/nrn1765.
[13]Liesz A,Rüger H,Purrucker J,et al.Stress mediators and immune dysfunction in patients with acute cerebrovascular diseases[J].PLo S One,2013,8(9):e74839.DOI:10.1371/journal.pone.0074839.
[14]Westendorp WF,Nederkoorn PJ,Vermeij JD,et al.Post-stroke infection:a systematic review and meta-analysis[J].BMC Neurol,2011(11):110.DOI:10.1186/1471-2377-11-110.
[15]Schwartz M,Kipnis J.Protective autoimmunity and neuroprotection in inflammatory and noninflammatoryneurodegenerative diseases[J].J Neurol Sci,2005,233(1-2):163-166.DOI:10.1016/j.jns.2005.03.014.
[2]Mayer SA,Sacco RL,Shi T,et al.Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage[J].Neurology,1994,44(8):1379-1384.
[3]Di Napoli M,Godoy DA,Campi V,et al.C-reactive protein in intracerebral hemorrhage:time course,tissue localization,and prognosis[J].Neurology,2012,79(7):690-699.DOI:10.1212/WNL.0b013e318264e3be.
[4]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.DOI:10.1161/STROKEAHA.116.013627.
[5]Inzitari D.The Italian Guidelines for stroke prevention.The Stroke Prevention and Educational Awareness Diffusion(SPREAD)Collaboration[J].Neurol Sci,2000,21(1):5-12.
[6]Lord AS,Gilmore E,Choi HA,et al.Time course and predictors of neurological deterioration after intracerebral hemorrhage[J].Stroke,2015,46(3):647-652.DOI:10.1161/STROKEAHA.114.007704.
[7]Lattanzi S,Cagnetti C,Provinciali L,et al.Blood pressure variability and clinical outcome in patients with acute intracerebralhemorrhage[J].J Stroke Cerebrovasc Dis,2015,24(7):1493-1499.DOI:10.1016/j.jstrokecerebrovasdis.2015.03.014.
[8]Lattanzi S,Silvestrini M.Blood pressure in acute intra-cerebral hemorrhage[J].Ann Transl Med,2016,4(16):320.DOI:10.21037/atm.2016.08.04.
[9]Wityk RJ,Pessin MS,Kaplan RF,et al.Serial assessment of acute stroke using the NIH stroke scale[J].Stroke,1994,25(2):362-365.
[10]Mracsko E,Javidi E,Na SY,et al.Leukocyte invasion of the brain after experimental intracerebral hemorrhage in mice[J].Stroke,2014,45(7):2107-2114.DOI:10.1161/STROKEAHA.114.005801.
[11]Moxon-Emre I,Schlichter LC.Neutrophil depletion reduces bloodbrain barrier breakdown,axon injury,and inflammation afterintracerebral hemorrhage[J].J Neuropathol Exp Neurol,2011,70(3):218-235.DOI:10.1097/NEN.0b013e31820d94a5.
[12]Meisel C,Schwab JM,Prass K,et al.Central nervous system injury-induced immune deficiency syndrome[J].Nat Rev Neurosci,2005,6(10):775-786.DOI:10.1038/nrn1765.
[13]Liesz A,Rüger H,Purrucker J,et al.Stress mediators and immune dysfunction in patients with acute cerebrovascular diseases[J].PLo S One,2013,8(9):e74839.DOI:10.1371/journal.pone.0074839.
[14]Westendorp WF,Nederkoorn PJ,Vermeij JD,et al.Post-stroke infection:a systematic review and meta-analysis[J].BMC Neurol,2011(11):110.DOI:10.1186/1471-2377-11-110.
[15]Schwartz M,Kipnis J.Protective autoimmunity and neuroprotection in inflammatory and noninflammatoryneurodegenerative diseases[J].J Neurol Sci,2005,233(1-2):163-166.DOI:10.1016/j.jns.2005.03.014.