摘要
目的研究并探讨高血压脑出血患者外周血淋巴细胞与单核细胞比值(LMR)与继发性脑水肿的关系。方法回顾性分析浙江大学舟山医院2019年6月至2021年6月因高血压脑出血住院治疗的患者57例。收集患者基本资料、入院血实验室指标和颅脑CT,有3~7 d复查颅脑CT等临床资料。根据头颅CT计算脑水肿指数(EI),根据EI将患者分为轻度(23例)及中重度脑水肿组(34例)。比较两组基线资料、LMR等实验室指标及影像学数据。将单因素分析有统计学意义的指标纳入Logistic回归模型,多因素二元Logistic回归分析明确高血压脑出血后中重度水肿的独立影响因素,绘制ROC曲线评估炎症指标对脑出血后中重度脑水肿的预测价值。结果57例高血压脑出血患者中,轻度脑水肿23例,中重度脑水肿34例。中重度脑水肿组白细胞计数、中性粒细胞计数、单核细胞计数、NLR值均明显高于轻度脑水肿组,而LMR值则显著低于轻度脑水肿组。多因素Logistic回归分析提示LMR较低[优势比(OR)=0.705;95%置信区间(CI)=0.528~0.940;P=0.017]是高血压脑出血患者出现继发性中重度脑水肿的独立危险因素。受试者工作特征曲线(ROC)表明LMR预测中重度继发性脑水肿的曲线下面积为0.703(95%CI=0.567~0.839;P=0.010),临界值为3.8597(敏感性70.6%;特异性65.2%)。结论高血压脑出血患者继发性脑水肿程度与LMR水平密切相关,入院后早期检测外周血LMR可以有效预测继发性脑水肿程度。
Objective To study and explore the correlation between lymphocyte-monocyte ratio(LMR)and secondary perihematomal edema in patients with hypertensive intracerebral hemorrhage.Methods 57 patients with hypertensive intracerebral hemorrhage in our hospital from June 2019 to June 2021 were retrospectively analyzed.The clinical data of the patients were collected,such as basic data,the major laboratory indicators,brain CT,and reexamination of brain CT after 3-7 days.And brain edema index(EI)was calculated according to brain CT.All patients were divided into mild edema group(23 cases)and moderate or severe edema group(34 cases)according to EI value.Baseline data,LMR and other laboratory indicators,and imaging data were compared between the two groups.The statistically significant indicators after single factor analysis were included in the multivariate logistic regression model.Then,multi-factor logistic regression analysis was used to identify the independent influencing factors of moderate or severe brain edema after hypertensive intracerebral hemorrhage.Eventually,ROC curve was drawn to evaluate the predictive value of inflammatory indexes for moderate or severe brain edema after intracerebral hemorrhage.Results Among all 57 patients with hypertensive intracerebral hemorrhage,23 cases were diagnosed mild brain edema,34 cases were moderate or severe.Compared with mild brain edema group,moderate or severe brain edema group had higher white blood cell count,neutrophil count,monocyte count and NLR value,while LMR value was significantly lower.Multivariate logistic regression analysis showed that low LMR value[odds ratio(OR)=0.705.95%confidence interval(CI)=0.528~0.940,P=0.017]was an independent risk factor for secondary moderate or severe brain edema in patients with hypertensive intracerebral hemorrhage.The area under the curve of LMR for predicting moderate or severe secondary brain edema was 0.703(95%CI=0.567~0.839,P=0.010),and the critical value was 3.8597(sensitivity=70.6%,specificity=65.2%).Conclusion The degree of secondary brain edema in patients with blood pressure intracerebral hemorrhage is closely related to the level of LMR.Early detection of peripheral blood LMR after admission can predict the degree of secondary brain edema effectively.
作者
邱华辉
QIU Huahui(Zhoushan Hospital of Zhejiang Province.Zhejiang 316021,China)
出处
《浙江创伤外科》
2023年第2期211-215,共5页
Zhejiang Journal of Traumatic Surgery
关键词
高血压脑出血
脑水肿
水肿指数
炎症
淋巴细胞与单核细胞比值
Hypertensive intracerebral hemorrhage
Brain edema
Edema index
Inflammation
Lymphocyte-monocyte ratio
