封萍，廖谷清，贺承健

（南华大学附属南华医院 重症医学科，湖南 衡阳 421002）

中性粒细胞与淋巴细胞比值对脑卒中相关性肺炎的预测价值

封萍，廖谷清，贺承健

（南华大学附属南华医院 重症医学科，湖南 衡阳 421002）

目的探讨血清中性粒细胞与淋巴细胞比值（NLR）对高血压病性脑出血患者发生卒中相关性肺炎（SAP）的预测价值。方法采用回顾性研究方法，选取2015年1月-2016年11月南华大学附属南华医院重症医学科收治的年龄在50～80岁，且住院时间≥7 d的118例高血压病性脑出血患者。根据患者入院后<7 d是否发生SAP将所有患者分为SAP组及非SAP组。比较两组患者的一般临床信息，分析入院时APACHEⅡ评分与入院后第1、3及5天的NLR值及白细胞（WBC）值的相关性，并评价两组患者在入院后第1、3及5天的WBC及NLR的变化以及组间差异，绘制受试者工作特征曲线（ROC曲线），评价不同时间各个指标对SAP发生的预测价值。结果入院时APACHEⅡ评分与入院后第3、5天的NLR水平第3天（r=0.360，P=0.000）；第5天（r=0.390，P=0.000）及 WBC 水平第 3天（r=0.220，P=0.015）；第 5天（r=0.200，P=0.031）呈正相关。SAP患者在入院后的第 1、3及 5天的 NLR 值分别为（10.89±3.05）、（12.42±3.75）及（9.28±3.31）。其中，第 3天的NLR值达到最高峰。且在第3、5天中，SAP组的WBC与NLR值均大于同期的非SAP组（P<0.05）。入院后第3、5天的NLR及WBC均能很好地预测SAP（P<0.05），2个时间的预测价值差异无统计学意义。且NLR的曲线下面积（AUC）（第3天为0.943，第5天为0.924）大于同期WBC的AUC值（第3天为0.823，第5天为0.809）。将NLR与WBC联合后不能增加曲线下面积。结论入院后第3、5天的NLR值对于评估SAP在临床上有很好的预测价值。

中性粒细胞与淋巴细胞比值；卒中相关性肺炎；白细胞；脑出血；APACHEⅡ评分

Abstract:ObjectiveTo assess the predictive value of neutrophils-lymphocytes ratio (NLR)in the stroke-associated pneumonia(SAP)of patients with intracerebral hemorrhage.MethodsThe clinical data for 118 patients with intracerebral hemorrhage who were treated in our ICU from Jannary 2015 to November 2016 were retrospectively extracted.All of them were between 50 and 80 years old,and their ICU lengths of stay were at least 7 days.Based on the occurrence of SAP in the first 7 days of admission,these patients were divided into SAP group and non-SAP group.The clinical information were analysed,as well as the correlation of acute physiology and chronic health evaluationⅡ (APACHEⅡ)score with NLR and white blood cell(WBC).The characteristics of NLR score and WBC score on the first,the third,the fifth days were compared,and the significant changes of them across groups were observed.The prognostic value of WBC and NLR at each time points in SAP were evaluated using receiver operating characteristic curve (ROC curve).ResultsThe APACHEⅡscore was significantly positively related to the level of NLR 3 d(r=0.360,P=0.000);5 d(r=0.390,P=0.000)and WBC 3 d (r=0.220,P=0.015);5 d (r=0.200,P=0.031)at third and fifth days.The NLR levels on the first day,the fifth day,the fifth day after admission in SAP group were (10.89±3.05);(12.42±3.75);(9.28±3.31)respectively,and the NLR on the third day was the highest.The WBC and NLR levels in SAP group were significantly higher than those in non-SAP group after the treatment for 3 days at the same time point(P<0.05).The area under the curve(AUC)of NLR and WBC on the third day and on the fifth day for SAP prediction were greater than that on the first day (P<0.05).There was no significant difference in prediction value of SAP between two time points.The NLR (AUC:3 d 0.943;5 d 0.924)were superior to WBC (AUC:3 d 0.823;5 d 0.809)for predicting SAP.The combination of NLR and WBC could not increase the AUC.Conclusion NLR score on the third,the fifth day is a certain indicator for predicting SAP in clinical practice.

Keywords:neutrophils-lymphocytes ratio;stroke-associated pneumonia;white blood cell;intracerebral hemorrhage;APACHEⅡscore

脑出血绝大多数是高血压小动脉硬化的血管破裂引起。为非外伤性，起病急骤、病情凶险，死亡率及致残率均较高，占急性脑卒中的10%～30%[1]。目前转往三级医院的多为脑出血患者，而脑梗死患者因为发展缓慢多在二级医院及下级医院就诊。脑出血患者的致死原因多由于脑疝形成及各种并发症，而最为常见的致死并发症就是肺部感染。2003年，HILKER等[2]首次提出卒中相关性肺炎，并在2015年的专家诊断共识中推荐卒中相关性肺炎（strokeassociated pneumonia，SAP）为非机械通气卒中患者发病后<1周发生肺炎的专业术语[3]。HARMS[4]在2013年报道过外周血白细胞计数>11×109/L也是SAP的危险因素，但是白细胞的重要组成部分包括中性粒细胞及淋巴细胞，采用白细胞计数反映病情欠细化。而国际上现对于SAP的发生机制主要为脑出血后导致神经-内分泌-免疫功能障碍引起免疫抑制有关，淋巴细胞是一种重要的免疫细胞，且在出现免疫抑制的疾病中会下降，因此结合中性粒细胞与淋巴细胞计数的比值（neutrophils-lymphocytes ratio，NLR）可能是一种更好的评价脑出血患者发生SAP的指标。……