不同时间点中性粒细胞/淋巴细胞比值与急性脑出血后脑水肿程度和短期预后的关系

Relationship between neutrophils to lymphocytes ratio and cerebral edema and short-term prognosis at different time points

摘要:

目的 探讨不同时间点中性粒细胞/淋巴细胞比值（NLR）与急性脑出血后脑水肿程度及预后的关系。方法 回顾性分析2016年8月—2019年6月广州中医药大学第一附属医院急性脑出血患者141例。根据30 d格拉斯哥预后评分（GOS）将患者分为预后良好组（GOS>3分）和预后不良组（GOS≤3分），比较两组不同时间点的的NLR。根据脑水肿体积将患者分为轻、中、重度3组，比较3组不同时间点的NLR。采用Spearman法分析NLR与急性脑出血脑水肿严重程度的相关性。结果 预后良好组与预后不良组比较：不同时间点的NLR有差异（P <0.05）；两组的NLR有差异（P <0.05），预后不良组高于预后良好组；两组的NLR变化趋势有差异（P <0.05），NLR随时间变化先增加后下降至最初水平。3组不同脑水肿严重程度组：不同时间点的NLR有差异（P <0.05）；3组的NLR有差异（P <0.05），脑出血脑水肿程度越高，NLR越高；3组的NLR随着时间变化先增加后下降（P <0.05），两组NLR变化趋势无差异（P >0.05）。Spearman相关性检验表明，NLR与急性脑出血后脑水肿严重程度呈正相关（r =0.406，P <0.05）。多因素一般Logistic回归分析表明，NLR［R=1.198（95% CI：1.023，1.404）］、脑出血后脑水肿严重程度［中度脑水肿：R=0.025（95% CI：0.003，0.227）；重度脑水肿：R=0.064（95% CI：0.007，0.629）］为30 d预后的独立危险因素。结论 NLR与急性脑出血后脑水肿严重程度及预后密切相关，临床可通过NLR指标来评估急性脑出血后脑水肿严重程度及预测预后情况。

Abstract:

Objective To investigate the relationship between neutrophil to lymphocyte radio in peripheral blood at different time points and the degree of cerebral edema and prognosis after acute cerebral hemorrhage.Methods From August 2016 to June 2019, 141 patients with acute cerebral hemorrhage admitted to the Department of Craniotomy of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were enrolled in this study. NLR levels at three time points were selected [T₁ was NLR level at admission (time from onset < 12 h); T₂ was 24 h to 48 h from onset time; T₃ was 5 to 7 d from onset time]. The patients were divided into 2 groups, good prognosis group (GOS > 3 points) and poor prognosis group (GOS ≤ 3 points), according to the 30 d GOS score. The levels of NLR at different time points in different prognostic groups were compared. According to the volume of cerebral edema, the patients were divided into three groups: light, moderate, and severe. The levels of NLR at different time points were compared in the three groups. Spearman correlation analysis was used to analyze the correlation between NLR levels and severity of brain edema in acute cerebral hemorrhage.Result The prognosis good group was compared to the prognosis group: there were statistical differences in the NLR level at different points (P < 0.05); the NLR level of the good prognosis group was statistically prior to that of the poor prognosis group (P < 0.05); there was a statistical difference in the trend of NLR score change between both groups (P < 0.05), and the NLR level was increased and then returned to the primary. Three groups of different cerebral edema groups showed: there were statistical differences in NLR levels at different points (P < 0.05); the NLR levels of the three different groups were statistically different (P < 0.05), and the higher the level of ICH cerebral edema was, the higher the NLR level was; the NLR levels of three groups increased and then decreased with the development of time (P < 0.05), but no difference appeared among the trend of NLR in three groups (P > 0.05). Spearman correlation test showed that NLR level was positively correlated with the severity of brain edema after acute cerebral hemorrhage (r = 0.406, P < 0.05). Binary logistic regression analysis showed that NLR [R = 1.198, (95% CI: 1.023, 1.404)], cerebral edema severity after cerebral hemorrhage (1) [R = 0.022, (95% CI: 0.001, 0.342)], cerebral edema severity after cerebral hemorrhage (2) [R = 0.061, (95% CI: 0.005, 0.796)] were an independent risk factor for 30-day prognosis.Conclusion The level of NLR is closely related to the severity and prognosis of cerebral edema after acute cerebral hemorrhage. The severity of cerebral edema and the prognosis after acute cerebral hemorrhage can be evaluated by NLR.