标题：术前中性粒细胞与淋巴细胞比值对重度颅脑外伤预后的预测价值

      作者：黎开宇，钟晖东，张海冰，吴一雷    (湛江市第二人民医院神经外科，广东 湛江 524003)

      卷次： 2018年29卷13期

      【摘要】 目的 探讨术前中性粒细胞与淋巴细胞比值(NLR)对重度颅脑外伤患者预后的预测价值。方法 回顾性收集2013年1月至2017年6月湛江市第二人民医院神经外科收治的204例重度颅脑外伤患者的临床病理资料。绘制受试者工作特征曲线(ROC)，分析NLR预测重度颅脑外伤患者预后的最佳临界值，并将患者分为高NLR组(84例)与低NLR组(120例)。按术后6个月的格拉斯哥预后量表(GOS)评分将患者分为预后不良组(98例)和预后良好组(106例)，比较两组的相关指标。采用多因素Logistic回归分析探讨重度颅脑外伤患者预后的独立影响因素。结果 术前NLR预测重度颅脑外伤预后的最佳临界值为3.79。单因素分析显示，重度颅脑外伤患者预后与中线移位、术后并发症、APACHEⅡ评分和术前NLR等指标密切相关(P<0.05)。多因素Logistic回归结果显示，中线移位≥5 mm、术后出现并发症、APACHEⅡ评分≥21以及术前NLR≥3.79是重度颅脑外伤患者术后出现预后不良的独立危险因素(P<0.05)。结论 术前NLR与重度颅脑外伤预后密切相关，可作为判断预后的一项重要指标。
      【关键词】 重度颅脑外伤；中性粒细胞与淋巴细胞比值；预后
      【中图分类号】 R651.1+5 【文献标识码】 A 【文章编号】 1003—6350（2018）13—1814—04

Predictive value of preoperative neutrophil to lymphocyte ratio on the prognosis of severe craniocerebral trauma.LI Kai-yu, ZHONG Hui-dong, ZHANG Hai-bing, WU Yi-lei.
Department of Neurosurgery, the Second People's Hospital ofZhanjiang, Zhanjiang 524003, Guangdong, CHINA
【Abstract】 Objective To investigate the predictive value of preoperative neutrophil to lymphocyte ratio (NLR)on the prognosis of severe craniocerebral trauma (SCCT). Methods The clinical data of 204 patients with SCCT whoadmitted to Department of Neurosurgery of the Second People's Hospital of Zhanjiang from January 2013 to June 2017were retrospectively analyzed. All patients were divided into two groups, namely high NLR group (n=84) and low NLRgroup (n=120), based on the optimal cut-off value by the receiver operating characteristics curves. The patients were alsoclassified into two groups according to the Glasgow outcome scale score of six months after surgery, namely poor prog-nosis group (n=98) and favorable prognosis group (n=106), of which the relative indexes were compared. Multiple logis-tic regression analysis was applied to explore the independent prognostic factors of SCCT. Results The optimal cut-offvalue of NLR was 3.79. Univariate analysis showed that the prognosis of SCCT was significantly associated with mid-line shift, postoperative complications, APACHE Ⅱ score, and preoperative NLR. Multiple logistic regression analysisdemonstrated that midline shift≥5 mm, postoperative complications, APACHE Ⅱ score≥21, and preoperative NLR≥3.79 were the independent risk factors for poor prognosis of SCCT. Conclusion Preoperative NLR is closely correlatedto the prognosis of SCCT, which could be an important prognostic index of SCCT.
      【Key words】 Severe craniocerebral trauma; Neutrophil to lymphocyte ratio; Prognosis·论 著·doi:10.3969/j.issn.1003-6350.2018.13.012基金项目：2017年度广东省湛江市科技攻关计划项目(编号：2017B01172)