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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2019, Vol. 05 ›› Issue (05) : 265 -268. doi: 10.3877/cma.j.issn.2095-9141.2019.05.003

所属专题： 文献；

临床研究

中性粒细胞淋巴细胞比值对术后并发颅内感染患者的预测价值
王玉荣1, 郑庆斌1, 韦广发1, 孟丽君1, 冯庆玲1, 袁文杰1, 欧金磊1, 刘微丽1, 李勇1,†()   
  1. 1. 225001　扬州，扬州大学附属医院重症医学科
  • 收稿日期:2019-06-11 出版日期:2019-10-15
  • 通信作者: 李勇
  • 基金资助:
    扬州市社会发展项目(YZ2017080)

Predictive value of neutrophil lymphocyte ratio in patients with postoperative intracranial infection

Yurong Wang1, Qingbin Zheng1, Guangfa Wei1, Lijun Meng1, Qingling Feng1, Wenjie Yuan1, Jinlei Ou1, Weili Liu1, Yong Li1,†()   

  1. 1. Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou 225001, China
  • Received:2019-06-11 Published:2019-10-15
  • Corresponding author: Yong Li
  • About author:
    Corresponding author: Li Yong, Email:
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引用本文：

王玉荣, 郑庆斌, 韦广发, 孟丽君, 冯庆玲, 袁文杰, 欧金磊, 刘微丽, 李勇. 中性粒细胞淋巴细胞比值对术后并发颅内感染患者的预测价值[J]. 中华神经创伤外科电子杂志, 2019, 05(05): 265-268.

Yurong Wang, Qingbin Zheng, Guangfa Wei, Lijun Meng, Qingling Feng, Wenjie Yuan, Jinlei Ou, Weili Liu, Yong Li. Predictive value of neutrophil lymphocyte ratio in patients with postoperative intracranial infection[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(05): 265-268.

目的

探讨术后中性粒细胞淋巴细胞比值（NLR）动态变化对颅脑外伤术后患者颅内感染的预测价值。

方法

选取扬州大学附属医院重症医学科自2012年1月至2018年12月收治的116例颅脑外伤并发术后颅内感染患者。根据患者术后第3天NLR的检测结果，NLR≥3为高NLR组，NLR<3为低NLR组，比较2组患者的临床预后情况。

结果

高NLR组患者在术后第3天NLR值明显升高，与低NLR组比较差异具有统计学意义（2.24±0.68 vs 4.72±1.21，P<0.05）。高NLR组患者颅内感染发生10例（19%），低NLR组颅内感染发生4例（6%），2组比较差异具有统计学意义（P=0.033）。NLR：曲线下面积（AUC）=0.894，95%CI：0.795~0.993；PCT：AUC=0.895，95%CI：0.764~1.027；CRP：AUC=0.898，95%CI：0.814~0.981。高NLR组患者ICU入住时间和机械通气时间均长于低NLR组，差异具有统计学意义（18.4±8.7 vs 13.2±5.4，P=0.000；10.3±4.7 vs 5.3±4.1，P=0.000）。高NLR组患者病死率高于低NLR组，差异具有统计学意义（P=0.026）。

结论

术后升高的NLR对颅脑外伤术后患者颅内感染的发生具有较好的临床预测价值，升高的NLR值和不良预后密切相关。

关键词: 中性粒细胞淋巴细胞比值, 颅脑外伤, 颅内感染
Objective

To explore the predictive value of dynamic changes of postoperative neutrophil lymphocyte ratio (NLR) in patients with craniocerebral trauma secondary intracranial infection.

Methods

One hundred sixteen patients with craniocerebral trauma secondary intracranial infection admitted to the Department of Critical Care Medicine, the Affiliated Hospital of Yangzhou University from January 2012 to December 2018 were included in the study. Patients were divided into a high NLR group (NLR≥3) and a low NLR group (NLR<3) based on the NLR measured on the third day after surgery. The difference in clinical outcome between the two groups was compared.

Results

NLR values were significantly higher in the high NLR group on the third postoperative day, and there was a significant statistical difference compared with the low NLR group (2.24±0.68 vs 4.72±1.21, P<0.05). In the high NLR group, 10 patients (19%) had intracranial infection, and 4 patients (6%) in the low NLR group. There was a significant statistical difference between the two groups (P=0.033). NLR: area under the curve (AUC)=0.894, 95%CI: 0.795-0.993; PCT: AUC=0.895, 95%CI: 0.764-1.027; CRP: AUC=0.898, 95%CI: 0.814-0.981. The ICU staying time and mechanical ventilation time were higher in the high NLR group than in the low NLR group. There was a statistical difference between the two groups (18.4±8.7 vs 13.2±5.4, P=0.000; 10.3±4.7 vs 5.3±4.1, P=0.000). The difference in mortality between the two groups was statistically significant. The mortality rate was higher in the high NLR group than in the low NLR group (P=0.026).

Conclusion

The elevated neutrophil lymphocyte ratio after surgery has a good clinical predictive value for the occurrence of intracranial infection in patients with craniocerebral trauma. The elevated NLR value is closely related to the poor prognosis.

Key words: Neutrophil lymphocyte ratio, Craniocerebral trauma, Intracranial infection
表1 2组患者的一般资料比较
项目 高NLR组(n=52) 低NLR组(n=64) t/χ2值 P值
年龄（岁） 51±17 52±15 0.336 0.737
男性(%) 27(52%) 35(55%) 0.088 0.767
GCS评分 5.2±1.7 5.7±1.9 1.477 0.142
APACHE-II评分 22±5 23±4 1.197 0.234
SOFA评分 7.1±1.7 6.9±1.6 0.651 0.516
C反应蛋白水平(mg/L) 83±36 75±29 1.326 0.188
降钙素原水平(ng/mL) 1.78±1.27 1.67±1.32 0.454 0.651
白细胞计数(×109) 13.5±5.1 12.1±4.6 1.553 0.123
体温 37.4±1.5 37.1±1.3 1.154 0.251
病因 ? ? ? ?
? 车祸伤 33(63%) 39(61%) 0.078 0.781
? 坠落伤 10(19%) 13(20%) 0.021 0.885
? 跌伤 6(12%) 9(14%) 0.162 0.687
? 攻击伤 3(6%) 3(5%) 0.068 0.794
手术情况 ? ? ? ?
? 急诊手术 38(73%) 31(48%) 7.227 0.007
? 择期手术 14(27%) 33(52%) - -
患者来源情况 ? ? ? ?
? 急诊室 35(67%) 30(47%) 4.862 0.028
? 普通病房 7(13%) 18(28%) 3.649 0.056
? 其他医院 10(20%) 16(25%) 0.549 0.459
图1 2组患者入住ICU后3 d的NLR变化图
图2 NLR、PCT、CRP的ROC曲线
表2 2组患者转归情况比较
参数 高NLR组(n=52) 低NLR组(n=64) t/χ2值 P值
再次入住ICU率 9(17%) 6(9%) 1.604 0.205
ICU入住时间(d) 18.4±8.7 13.2±5.4 3.940 0.000
机械通气时间(d) 10.3±4.7 5.3±4.1 6.189 0.000
肾脏支持比率 10(19%) 14(22%) 0.122 0.727
图3 2组患者30 d生存率Kaplan-meier生存分析
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