血小板-淋巴细胞比值对颅脑损伤患者6个月预后的预测价值

doi:10.3877/cma.j.issn.2095-9141.2022.03.004

目的

探讨血小板-淋巴细胞比值（PLR）预测颅脑损伤（TBI）患者6个月预后的价值。

方法

回顾性分析安徽省阜阳市第五人民医院神经外科自2017年1月至2021年2月收治的346例TBI患者的临床资料。根据患者出院后6个月的扩展格拉斯哥预后（GOS-E）量表评分将患者分为预后不良组（GOS-E评分≤4分）和预后良好组（GOS-E评分5~8分）。通过单因素和多因素Logistic回归分析影响预后不良的危险因素。建立3个基于入院时临床资料的预测模型，采用受试者工作特征（ROC）曲线和曲线下面积（AUC）分析PLR对TBI患者6个月预后的预测价值。

结果

346例TBI患者中，280例患者预后良好（预后良好组），66例患者预后不良（预后不良组）。单因素分析和多因素Logistic回归分析结果显示，高龄、入院时较低的GCS评分、高白细胞计数、低血小板计数和较低的PLR是TBI患者预后的独立危险因素。ROC曲线分析结果显示，结合PLR和标准变量的模型更有利于预测TBI患者6个月的预后（AUC=0.957，95%CI：0.931~0.976）。

结论

入院时PLR水平具有较好预测TBI患者6个月预后不良的价值。

关键词: 颅脑损伤, 血小板-淋巴细胞比值, 预后

Objective

To investigate the value of platelet-to-lymphocyte ratio (PLR) for predicting the 6-month outcome of patients with traumatic brain injury (TBI).

Methods

The clinical data of 346 TBI patients who were admitted to the Neurosurgery Department of Fuyang Fifth People’s Hospital of Anhui Province from January 2017 to February 2021 were retrospectively reviewed. The patients were divided into a poor prognosis group (GOS-E score ≤ 4 points) and a good prognosis group (GOS-E score 5-8 points) according to GOS-E progonosis scores at 6 months after discharge. Univariate and multivariate Logistic regression analyses were used to assess the risk factors of poor prognosis. Three predictive models based on admission characteristics were built with receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate the prognostic value of the PLR in predicting the 6-month outcome of patients with TBI.

Results

Of 346 TBI patients, 280 patients had a good prognosis (good prognosis group) and 66 patients had a poor prognosis (poor prognosis group). The results of univariate and multivariate Logistic regression analysis showed that advanced age, low GCS score at admission, high leukocyte count, low platelet count and low PLR were independent risk factors for prognosis in patients with TBI. ROC curve analysis showed that the model combining the PLR and standard variables (AUC=0.957, 95%CI: 0.931-0.976) was more favorable in predicting 6-month outcome of patients with TBI.

Conclusion

The level of PLR at admission has great predictive value for 6-month prognosis of patients with TBI in 6 months.

Key words: Traumatic brain injury, Platelet-to-lymphocyte ratio, Prognosis

表1 颅脑损伤预后影响因素的单因素分析

影响因素		预后良好组(n=280)	预后不良组(n=66)	χ²/t/U值	P值
年龄（岁，±s）		56.08±16.77	63.15±15.00	-3.144	0.002
性别（男/女）		189/91	43/23	0.133	0.715
入院时GCS评分[例(%)]				144.506	<0.001
	3~8分	29(10.4)	53(80.3)
	9~15分	251(89.6)	13(19.7)
致伤机制[例(%)]				1.046	0.593
	跌倒	172(61.4)	39(59.1)
	交通事故	98(35.0)	26(39.4)
	其他	10(3.6)	1(1.5)
合并多发伤[例(%)]		89(31.8)	28(42.4)	2.701	0.100
合并高血压[例(%)]		72(25.7)	22(33.3)	1.567	0.211
合并烟酒史[例(%)]		23(8.2)	10(15.2)	2.979	0.084
实验室检查
	白细胞计数[10⁹/L，M(P₂₅，P₇₅)]	11.31(8.87,13.87)	11.83(9.68,18.76)	-2.287	<0.001
	中性粒细胞[10⁹/L，M(P₂₅，P₇₅)]	9.31(6.74,12.32)	9.38(7.15,15.57)	-1.313	0.003
	淋巴细胞[10⁹/L，M(P₂₅，P₇₅)]	1.07(0.76,1.54)	1.21(0.77,2.99)	-1.867	<0.001
	血红蛋白[g/L，M(P₂₅，P₇₅)]	132(119.00,145.00)	128(111.75,141.25)	-1.787	0.074
	血小板计数[10⁹/L，M(P₂₅，P₇₅)]	178.50(147.00,217.00)	164.50(126.00,189.25)	-2.632	0.008
	血小板-中性粒细胞比值[M(P₂₅，P₇₅)]	18.69(13.38,27.73)	15.88(9.38,23.01)	-3.222	0.001
	中性粒细胞-淋巴细胞比值[M(P₂₅，P₇₅)]	9.15(4.75,15.29)	9.38(3.51,17.16)	-0.005	0.996
	血小板-淋巴细胞比值[M(P₂₅，P₇₅)]	156.69(112.53,227.67)	118.92(60.68,190.14)	-3.527	<0.001
	血小板-白细胞比值[M(P₂₅，P₇₅)]	15.57(11.57,21.28)	12.77(8.18,16.22)	-4.347	<0.001
	白蛋白[g/L，M(P₂₅，P₇₅)]	39.30(36.13,42.10)	33.55(30.10,37.94)	-5.963	<0.001
	前白蛋白（mg/L，±s）	200.28±53.90	172.30±51.28	3.828	<0.001
	凝血酶原时间[s，M(P₂₅，P₇₅)]	11.60(10.70,12.18)	12.15(11.60,13.90)	-4.616	<0.001
	活化部分凝血活酶时间[s，M(P₂₅，P₇₅)]	27.60(25.70,29.60)	27.95(25.48,30.85)	-0.667	0.008
	国际标准化比值[M(P₂₅，P₇₅)]	1.03(0.95,1.08)	1.07(1.02,1.24)	-4.290	<0.001
	D-二聚体[mg/L，M(P₂₅，P₇₅)]	13.32(7.31,13.32)	13.32(6.69,19.02)	-2.543	<0.001

表1 颅脑损伤预后影响因素的单因素分析

影响因素		预后良好组(n=280)	预后不良组(n=66)	χ²/t/U值	P值
年龄（岁，±s）		56.08±16.77	63.15±15.00	-3.144	0.002
性别（男/女）		189/91	43/23	0.133	0.715
入院时GCS评分[例(%)]				144.506	<0.001
	3~8分	29(10.4)	53(80.3)
	9~15分	251(89.6)	13(19.7)
致伤机制[例(%)]				1.046	0.593
	跌倒	172(61.4)	39(59.1)
	交通事故	98(35.0)	26(39.4)
	其他	10(3.6)	1(1.5)
合并多发伤[例(%)]		89(31.8)	28(42.4)	2.701	0.100
合并高血压[例(%)]		72(25.7)	22(33.3)	1.567	0.211
合并烟酒史[例(%)]		23(8.2)	10(15.2)	2.979	0.084
实验室检查
	白细胞计数[10⁹/L，M(P₂₅，P₇₅)]	11.31(8.87,13.87)	11.83(9.68,18.76)	-2.287	<0.001
	中性粒细胞[10⁹/L，M(P₂₅，P₇₅)]	9.31(6.74,12.32)	9.38(7.15,15.57)	-1.313	0.003
	淋巴细胞[10⁹/L，M(P₂₅，P₇₅)]	1.07(0.76,1.54)	1.21(0.77,2.99)	-1.867	<0.001
	血红蛋白[g/L，M(P₂₅，P₇₅)]	132(119.00,145.00)	128(111.75,141.25)	-1.787	0.074
	血小板计数[10⁹/L，M(P₂₅，P₇₅)]	178.50(147.00,217.00)	164.50(126.00,189.25)	-2.632	0.008
	血小板-中性粒细胞比值[M(P₂₅，P₇₅)]	18.69(13.38,27.73)	15.88(9.38,23.01)	-3.222	0.001
	中性粒细胞-淋巴细胞比值[M(P₂₅，P₇₅)]	9.15(4.75,15.29)	9.38(3.51,17.16)	-0.005	0.996
	血小板-淋巴细胞比值[M(P₂₅，P₇₅)]	156.69(112.53,227.67)	118.92(60.68,190.14)	-3.527	<0.001
	血小板-白细胞比值[M(P₂₅，P₇₅)]	15.57(11.57,21.28)	12.77(8.18,16.22)	-4.347	<0.001
	白蛋白[g/L，M(P₂₅，P₇₅)]	39.30(36.13,42.10)	33.55(30.10,37.94)	-5.963	<0.001
	前白蛋白（mg/L，±s）	200.28±53.90	172.30±51.28	3.828	<0.001
	凝血酶原时间[s，M(P₂₅，P₇₅)]	11.60(10.70,12.18)	12.15(11.60,13.90)	-4.616	<0.001
	活化部分凝血活酶时间[s，M(P₂₅，P₇₅)]	27.60(25.70,29.60)	27.95(25.48,30.85)	-0.667	0.008
	国际标准化比值[M(P₂₅，P₇₅)]	1.03(0.95,1.08)	1.07(1.02,1.24)	-4.290	<0.001
	D-二聚体[mg/L，M(P₂₅，P₇₅)]	13.32(7.31,13.32)	13.32(6.69,19.02)	-2.543	<0.001

表2 颅脑损伤预后影响因素的多因素Logistic回归分析

危险因素	偏回归系数	标准误	Wald值	OR值	95%CI	P值
年龄	0.058	0.016	12.576	1.059	1.026~1.094	<0.001
GCS评分
9~15分				Ref
3~8分	3.566	0.406	77.044	35.392	15.960~78.482	<0.001
白细胞计数	0.568	0.288	3.896	1.765	1.004~3.102	0.048
血小板计数	-0.022	0.008	6.979	0.979	0.963~0.994	0.008
血小板-淋巴细胞比值	0.005	0.003	4.356	1.005	1.000~1.010	0.037

表2 颅脑损伤预后影响因素的多因素Logistic回归分析

危险因素	偏回归系数	标准误	Wald值	OR值	95%CI	P值
年龄	0.058	0.016	12.576	1.059	1.026~1.094	<0.001
GCS评分
9~15分				Ref
3~8分	3.566	0.406	77.044	35.392	15.960~78.482	<0.001
白细胞计数	0.568	0.288	3.896	1.765	1.004~3.102	0.048
血小板计数	-0.022	0.008	6.979	0.979	0.963~0.994	0.008
血小板-淋巴细胞比值	0.005	0.003	4.356	1.005	1.000~1.010	0.037

图1 不同危险因素预测预后的受试者工作特征曲线

表3 不同危险因素预测预后的曲线下面积

危险因素	曲线下面积	敏感度	特异度	截断值	95%CI	P值
年龄	0.631	57.58	63.21	62.00	0.577~0.682	<0.001
GCS评分	0.923	84.85	86.79	9.00	0.890~0.949	<0.001
白细胞计数	0.590	33.33	85.36	15.94	0.537~0.643	0.027
血小板计数	0.604	78.79	42.14	191.00	0.550~0.656	0.006
血小板-淋巴细胞比值	0.640	43.94	83.21	92.61	0.586~0.690	0.001

表3 不同危险因素预测预后的曲线下面积

危险因素	曲线下面积	敏感度	特异度	截断值	95%CI	P值
年龄	0.631	57.58	63.21	62.00	0.577~0.682	<0.001
GCS评分	0.923	84.85	86.79	9.00	0.890~0.949	<0.001
白细胞计数	0.590	33.33	85.36	15.94	0.537~0.643	0.027
血小板计数	0.604	78.79	42.14	191.00	0.550~0.656	0.006
血小板-淋巴细胞比值	0.640	43.94	83.21	92.61	0.586~0.690	0.001

图2 3个预测模型的的受试者工作特征曲线

表4 3个预测模型的曲线下面积

预测模型	曲线下面积	敏感度	特异度	95%CI	P值
模型1	0.938	89.39	85.36	0.907~0.961	<0.001
模型2	0.957	89.39	87.86	0.931~0.976	<0.001
模型3	0.858	81.82	76.43	0.817~0.893	<0.001

表4 3个预测模型的曲线下面积

预测模型	曲线下面积	敏感度	特异度	95%CI	P值
模型1	0.938	89.39	85.36	0.907~0.961	<0.001
模型2	0.957	89.39	87.86	0.931~0.976	<0.001
模型3	0.858	81.82	76.43	0.817~0.893	<0.001

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Prognostic value of platelet-to-lymphocyte ratio in predicting the 6-month outcome of patients with traumatic brain injury

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Prognostic value of platelet-to-lymphocyte ratio in predicting the 6-month outcome of patients with traumatic brain injury