术前免疫炎症指标CAR联合NLR在基底节区出血手术患者预后中的应用研究

doi:10.19854/j.cnki.1008-2425.2023.04.0008

摘要/Abstract

摘要： 目的探讨术前免疫炎症指标C反应蛋白-白蛋白比(C-reactive protein-Albuminratio,CAR)联合中性粒细胞-淋巴细胞比(Neutrophil-Lymphocyte ratio,NLR)在基底节区出血手术患者预后中的应用价值。方法回顾性分析2020年1月至2022年12月在金寨县中医院行手术治疗的50例基底节区出血患者的临床资料,收集患者术前血液检验数据。根据术后3个月的改良mRS评分将患者分为预后良好组和预后不良组,利用ROC曲线和Logistic回归分析评估术前CAR联合NLR在患者预后中的预测价值。结果术前CAR和NLR在预后不良组中的表达水平明显高于预后良好组(P=0.000,P=0.027)。Logistic回归分析显示术前CAR、NLR和GCS评分均为影响预后的独立危险因素(P=0.010,P=0.032,P=0.028)。ROC曲线分析显示术前CAR和NLR的最佳分界值分别为2.52和2.71,且二者联合预测不良预后的AUC、敏感度和特异度均优于各自单独应用时。结论术前免疫炎症指标CAR联合NLR,在基底节区出血手术患者预后中具有重要的临床应用价值。

关键词: CAR, NLR, 基底节区出血, 术后, 预后

Abstract: Objective To explore the application value of preoperative immune inflammatory index C-reactive protein-Albumin ratio (CAR) combined with Neutrophil-Lymphocyte ratio (NLR) in the prognosis of patients with basal ganglia hemorrhage.Methods The clinical data of 50 patients with basal ganglia hemorrhage who underwent surgical treatment in Jinzhai Chinese Medicine Hospital from January 2020 to December 2022 were retrospectively analyzed,and the data of preoperative blood tests were collected.According to the modified mRSscore of3 months after operation,the patients were divided into two groups:good prognosis group and poor prognosis group.ROC curve and Logistic regression analysis were used to evaluate the predictive value of preoperative CAR combined with NLR in the prognosis of patients.Results The expression levels of preoperative CAR and NLR in patients with poor prognosis were significantly higher than those in patients with good prognosis (P=0.000,P=0.027).Logistic regression analysis showed that preoperative CAR,NLR and GCS scores were independent risk factors for prognosis (P=0.010,P=0.032,P=0.028).ROC curve analysis shows that the optimal cutoff values of preoperative CAR and NLR are 2.52 and 2.71.And the AUC,sensitivity and specificity of the combined prediction of adverse prognosis are better than those of the single application.Conclusion The preoperative immune inflammatory index CAR combined with NLR has important clinical application value in predicting the prognosis of patients with basal ganglia hemorrhage.

Key words: CAR, NLR, Basal ganglia area hemorrhage, Postoperative, Prognosis

中图分类号:

R743.34

陈圣典, 许恕, 冯兴隆, 陈义维, 侯仕强. 术前免疫炎症指标CAR联合NLR在基底节区出血手术患者预后中的应用研究[J]. 立体定向和功能性神经外科杂志, 2023, 36(4): 233-236.

Chen Shengdian, Xu Shu, Feng Xinglong, et al. Application of preoperative immune inflammatory index CAR combined with NLR in postoperative prognosis of patients with basal ganglia areahemorrhage[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(4): 233-236.

参考文献

[1] 姚国权,侯仕强,林宁.显微镜下手术治疗高血压基底节脑出血的疗效观察[J].中华全科医学,2020,18(7):1131~1133.
[2] 叶枝秀,吴克义,唐朝亮.右美托咪定对高血压脑出血患者围术期血清IL-6和IL-11的表达及神经功能的影响[J].立体定向和功能性神经外科杂志,2020,33(6):359~362.
[3] 黄黎莹,赛芳芳,张科蓓,等.高血压脑出血患者入院时血总钙水平与预后的相关性[J].检验医学,2022,37(5):423~428.
[4] 付为刚,陈永翱,李道龙,等.纤维蛋白原与前白蛋白比值预测原发性急性脑出血患者90d预后价值[J].创伤与急危重病医学,2021,9(3):211~215.
[5] Bao Y,Yang J,Duan Y,et al.The C-reactive protein to albumin ratio is an excellent prognostic predictor for gallbladder cancer[J].Biosci Trends.2021,14(6):428~435.
[6] Sayar S,Kurbuz K,Kahraman R,et al.A practical marker to determining acute severe ulcerative colitis:CRP/albumin ratio[J].North Clin Istanb.2019,7(1):49~55.
[7] 王瑾,刘晶,刘文艳,等.急性脑出血患者C反应蛋白和白蛋白比值与30天格拉斯哥预后评分的关联评估[J].中华老年心脑血管病杂志,2023,25(1):44~47.
[8] 邱玉霞,孙月玲,宫保强,等.Alb及NLR对创伤性脑出血患者的近期预后价值[J].国际神经病学神经外科学杂志,2019,46(1):26~30.
[9] 徐磊,古红香,李兴义,等.IL-18、NLR和NLRP3水平与高血压性脑出血严重程度及预后的关系[J].分子诊断与治疗杂志,2022,14(10):1765~1769.
[10] 苗鹏飞,李想,韩亚南,等.中性粒细胞-淋巴细胞比及血小板参数与老年脑出血患者预后的相关性[J].中华老年医学杂志,2020,39(7):800~803.
[11] 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):435~442.
[12] 纪延伟,潘强,殷长江,等.血清PDGF预测脑出血微创穿刺治疗短期预后评估[J].立体定向和功能性神经外科杂志,2020,33(3):180~185.
[13] 黄剑,何贵文,蔡学坚,等.NGF和IL-6在对高血压脑出血患者中的表达水平及临床意义[J].立体定向和功能性神经外科杂志,2021,34(1):28~31.
[14] 卜君辉,梁赛,吴继伟,等.血清TIMP-1、TIM-3mRNA及CTRP-3水平与高血压脑出血手术患者神经功能损伤程度及预后相关性研究[J].立体定向和功能性神经外科杂志,2021,34(1):28~31.
[15] Herwald H,Egesten A.C-Reactive Protein:More than a Biomarker[J].J Innate Immun.2021,13(5):257~258.
[16] 张海垠,黄艳丽.hs-CRP、NSE在急性脑出血患者诊治过程中的应用价值[J].中国实验诊断学,2019,23(7):1119~1121.
[17] Ito T,Shinkawa H,Takemura S,et al.Impact of the Preoperative C-reactive Protein to Albumin Ratio on the Long-Term Outcomes of Hepatic Resection for Intrahepatic Cholangiocarcinoma[J].Asian Pac J Cancer Prev.2020,21(8):2373~2379.
[18] 霍瑞民,李炜莉.三七总皂苷分期治疗高血压性脑出血及对血肿、高敏C反应蛋白的影响[J].陕西中医,2017,38(10):1370~1372.
[19] 陈臻,何其胜,邓志,等.大黄三七散联合尼莫地平对高血压脑出血患者血清C3、C4和hs-CRP的影响[J].现代中西医结合杂志,2018,27(31):3473~3475.
[20] 张杰,邢益桓,颜为国,等.高血压脑出血微创穿刺引流术后采用中医分阶段治疗方案的疗效评估[J].中医药导报,2021,27(1):86~90.