摘要
目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)评估维持性血液透析(MHD)合并脑出血患者预后的临床应用价值。方法回顾性分析2015年1月至2019年5月徐州医科大学附属医院收治的56例MHD合并脑出血患者的临床资料,根据第3个月改良Rankin量表评分将患者分为预后良好组(21例)和预后不良组(35例)。比较两组患者的基线资料、实验室指标及器械检查结果,行多因素Logistic回归分析MHD合并脑出血预后的危险因素。运用受试者工作特征曲线比较NLR与其他炎症指标在MHD合并脑出血患者预后方面的预测效能。结果预后不良组入院格拉斯哥昏迷评分、血红蛋白、白蛋白均低于预后良好组[6(4,12)分比14(13,15)分,85.5(70.0,97.0)g/L比96.0(85.0,101.0)g/L,(35.9±4.3)g/L比(38.8±3.5)g/L](P<0.05),白细胞计数、NLR、血小板计数与淋巴细胞比值(PLR)、高敏C反应蛋白(hs-CRP)、出血量均高于预后良好组[7.1(5.3,11.3)×109/L比5.9(3.8,8.8)×109/L,10.3(7.4,16.9)比5.8(4.6,7.3),219.6(159.4,338.0)比148.5(118.5,214.1),11.0(5.6,46.9)mg/L比6.7(3.3,17.2)mg/L,33.2(10.0,86.0)mL比13.8(4.7,18.5)mL](P<0.05)。多因素Logistic回归分析结果显示:NLR为影响患者预后的独立危险因素(OR=1.308,95%CI 1.010~1.693,P=0.042),血红蛋白为影响患者预后的保护因素(OR=0.915,95%CI 0.849~0.987,P=0.021)。白细胞计数、NLR、PLR、hs-CRP预测患者预后的曲线下面积分别为0.677、0.819、0.748、0.673(均P<0.05)。结论MHD合并脑出血患者具有高风险、高死亡率的临床特点,预后不良组的NLR水平明显高于预后良好组,NLR对其预后有一定的预测价值。
Objective To analyze the clinical significance of peripheral blood neutrophil-to-lymphocyte ratio(NLR)for assessing the prognosis in patients with maintenance hemodialysis(MHD)complicated with intracerebral hemorrhage.Methods The clinical data of 56 patients with MHD complicated with intracerebral hemorrhage in the Affiliated Hospital of Xuzhou Medical University from Jan.2015 to May 2019 were retrospectively analyzed.According to the modified Rankin scale score at the 3rd month,the patients were divided into a good prognosis group(21 cases)and a poor prognosis group(35 cases).Univariate analysis of the risk factors affecting the prognosis of the two groups of patients was done,and then based on multifactor Logistic regression analysis the independent risk factors of the prognosis were determined.The receiver operating characteristic(ROC)curve was used to compare the predictive efficacy of NLR and other inflammatory indicators for the prognostic judgment.Results The Glasgow coma score,hemoglobin,and serum albumin of the poor prognosis group were lower than those in the good prognosis group[6(4,12)vs 14(13,15),85.5(70.0,97.0)g/L vs 96.0(85.0,101.0)g/L,(35.9±4.3)g/L vs(38.8±3.5)g/L](P<0.05).The white blood cell count,NLR,platelet-to-lymphocyte ratio(PLR),high sensitive-C reactive protein(hs-CRP),and bleeding volume in the poor prognosis group were higher than those in the good prognosis group[7.1(5.3,11.3)×109/L vs 5.9(3.8,8.8)×109/L,10.3(7.4,16.9)vs 5.8(4.6,7.3),219.6(159.4,338.0)vs 148.5(118.5,214.1),11.0(5.6,46.9)mg/L vs 6.7(3.3,17.2)mg/L,33.2(10.0,86.0)mL vs 13.8(4.7,18.5)mL](P<0.05).Multivariate Logistic regression showed that NLR was an independent risk factor for poor prognosis(OR=1.308,95%CI 1.010-1.693,P=0.042),and hemoglobin was a protective factor for the prognosis(OR=0.915,95%CI 0.849-0.987,P=0.021).The area under curve of ROC curve of the white blood cell count,NLR,PLR,and hs-CRP for prognosis prediction was 0.677,0.819,0.748,and 0.673,respectively(all P<0.05).Conclusion The patients with MHD complicated with intracerebral haemorrhage have the clinical characteristics of high risk and high mortality.NLR in the poor prognosis group is significantly higher than those in the good prognosis group,so NLR has a certain predictive value for the prognosis.
作者
蒋甘孺
金彬彬
张明珠
刘亚
李胜开
JIANG Ganru;JIN Binbin;ZHANG Mingzhu;LIU Ya;LI Shengkai(Department of Nephrology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;Xuzhou Medical University,Xuzhou 221000,China)
出处
《医学综述》
2020年第20期4127-4131,4136,共6页
Medical Recapitulate
基金
江苏省自然科学基金(BK20151152)。
关键词
脑出血
维持性血液透析
中性粒细胞与淋巴细胞比值
预后
Intracerebral hemorrhage
Maintenance hemodialysis
Neutrophil-to-lymphocyte ratio
Prognosis
作者简介
通信作者:李胜开,Email:lsk2869388@126.com。
