白细胞分类计数及NLR与急性脑梗死严重程度及不良预后的相关性研究

发布时间：2018-06-01 20:09

本文选题：急性脑梗死 + 中性粒细胞-淋巴细胞比值　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:探讨外周血早期白细胞总数、中性粒细胞计数、淋巴细胞计数、中性粒细胞-淋巴细胞比值与急性脑梗死严重程度及不良预后的相关性。方法:选取2016年01月至2016年10月就诊于兰大二院神经内科且发病72h内的急性脑梗死患者235例,以及同期性别、年龄相匹配的健康体检人群30例作为对照组。(1)依据入院患者的NIHSS评分,将研究人群分为轻度、中度和重度3组,比较各组间白细胞分类计数和NLR水平,分析白细胞分类计数和NLR与急性脑梗死患者神经功能损伤程度的相关性。(2)依据患者DWI图像上显示的梗死面积大小,将研究人群分为腔隙性梗死组、中等面积梗死组、大面积梗死组,比较3组间白细胞分类计数和NLR水平,使用ROC曲线计算和比较白细胞分类计数和NLR对大面积脑梗死预测价值,计算其最佳分界值、敏感性、特异性。(3)依据患者发病90d的mRS评分,进一步将研究人群分为预后良好组与预后不良组,比较2组间白细胞分类计数和NLR水平,分析白细胞分类计数和NLR与急性脑梗死患者发病90d不良预后的相关性,使用ROC曲线计算和比较白细胞分类计数和NLR对发病90d不良预后的预测价值,计算其最佳分界值、敏感性、特异性。结果:(1)急性脑梗死组白细胞总数、中性粒细胞计数及NLR水平均显著高于对照组(P0.001),而淋巴细胞计数低于对照组(P0.05);轻、中、重度脑梗死患者白细胞总数、中性粒细胞计数和NLR水平依次升高,淋巴细胞计数依次降低,组间比较差异存在统计学意义(P0.05);白细胞总数、中性粒细胞计数、NLR与神经功能缺损程度呈正相关(r=0.413,P=0.000;r=0.508,P=0.000;r=0.519,P=0.000);淋巴细胞计数与神经功能缺损程度呈负相关(r=-0.201,P=0.012)。(2)腔隙性、中等面积、大面积脑梗死患者白细胞总数、中性粒细胞计数和NLR水平水平依次升高,淋巴细胞计数依次降低,组间比较差异存在统计学意义(P0.001);NLR预测大面积脑梗死的最佳界值为3.49(曲线下面积0.801,敏感性85.23%,特异性71.54%)。(3)预后不良组白细胞总数、中性粒细胞计数和NLR水平水平均显著高于预后良好组(P0.001),淋巴细胞计数低于预后良好组(P=0.099);白细胞总数、中性粒细胞计数和NLR水平与发病90d的mRS评分呈正相关(r=0.222,P=0.012;r=0.325,P0.001;r=0.399,P0.001);NLR预测发病90d不良预后的最佳界值为4.16(曲线下面积0.708,敏感性71.01%,特异性70.18%)。结论:(1)外周血早期白细胞分类计数和NLR水平可反映急性脑梗死患者神经功能损伤程度,且NLR相关性更好,监测其水平变化有助于对患者病情进行早期评估;(2)外周血早期白细胞分类计数和NLR水平对大面积脑梗死有一定预测价值,NLR的预测价值更大。(3)外周血早期白细胞分类计数和NLR水平对发病90d不良预后有一定的预测价值,NLR的预测价值更大。
[Abstract]:Objective: To investigate the correlation between the total number of white blood cells in early peripheral blood, neutrophils count, lymphocyte count, neutrophils - lymphocyte ratio and the severity of acute cerebral infarction and the adverse prognosis. Methods: 235 cases of acute cerebral infarction in the second hospital of Landa Department of Neurology and 72h in 72h were selected from 2016 to October 2016. 30 cases of healthy people with matched age and sex were used as control group. (1) according to the NIHSS score of hospitalized patients, the study group was divided into mild, moderate and severe group, and the leucocyte count and NLR level were compared between each group, and the correlation between the white blood cell count and the correlation between NLR and the degree of nerve function injury in patients with acute cerebral infarction was analyzed. (2) according to the size of infarct area displayed on the patient's DWI image, the study group was divided into lacunar infarction group, medium area infarction group and large area infarction group, compared the white blood cell classification count and NLR level among the 3 groups. The ROC curve was used to calculate and compare the value of white blood cell count and NLR to the large area cerebral infarction, and the best boundary value was calculated. (3) according to the mRS score of patients with 90d, the study group was further divided into good prognosis group and poor prognosis group, and compared the white blood cell count and NLR level among the 2 groups, the correlation between white blood cell count and NLR and the adverse prognosis of 90d in patients with acute cerebral infarction was analyzed, and the ROC curve was used to calculate and compare white blood cells. The results were as follows: (1) the total number of leukocytes, the count of neutrophils and the level of NLR were significantly higher than that of the control group (P0.001), but the count of lymphocyte was lower than that of the control group (P0.05), and the total white blood cell of the patients with mild, moderate and severe cerebral infarction was total (1). The count of neutrophils and NLR increased in turn, the lymphocyte count decreased in turn, and there was a significant difference between the groups (P0.05); the total number of white blood cells, neutrophils count, and NLR were positively correlated with the degree of nerve function defect (r=0.413, P=0.000; r=0.508, P=0.000; r=0.519, P=0.000); lymphocyte count and nerve function defect The degree was negative correlation (r=-0.201, P=0.012). (2) lacunar, medium area, large area cerebral infarction patients, the total number of leukocytes, neutrophils count and NLR level in turn, the lymphocyte count decreased in turn, the difference between the groups was statistically significant (P0.001); the best boundary value of NLR for predicting large area cerebral infarction was the area under the curve. 0.801, sensitivity 85.23%, specificity 71.54%). (3) the total number of leukocytes in poor prognosis group, neutrophils count and NLR level were significantly higher than that of good prognosis group (P0.001), lymphocyte count was lower than good prognosis group (P=0.099), leukocyte count, neutrophils count and NLR level were positively correlated with mRS score of 90d (r=0.222, P=0.0) 12; r=0.325, P0.001; r=0.399, P0.001); the best boundary value of NLR to predict bad prognosis of 90d was 4.16 (under curve area 0.708, sensitivity 71.01%, specificity 70.18%). Conclusion: (1) the classification and NLR level of white blood cells in peripheral blood can reflect the degree of neurological impairment in patients with acute cerebral infarction, and the correlation of NLR is better and the level changes are monitored. It is helpful to the early assessment of the patient's condition; (2) the white blood cell count and NLR level in the early peripheral blood have certain predictive value for the large area cerebral infarction, and the predictive value of NLR is greater. (3) the early peripheral blood leukocyte count and the NLR level have a definite predictive value for the bad prognosis of the onset of 90d, and the predictive value of NLR is greater.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

【相似文献】