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基于单核细胞的炎症指标预测蛛网膜下腔出血后结局。

Monocyte-based inflammatory indices predict outcomes following aneurysmal subarachnoid hemorrhage.

机构信息

Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps Building, Suite 102, Baltimore, MD, 21287, USA.

出版信息

Neurosurg Rev. 2021 Dec;44(6):3499-3507. doi: 10.1007/s10143-021-01525-1. Epub 2021 Apr 10.

Abstract

The contribution of specific immune cell populations to the post-hemorrhagic inflammatory response in aneurysmal subarachnoid hemorrhage (aSAH) and correlations with clinical outcomes, such as vasospasm and functional status, remains unclear. We aimed to compare the predictive value of leukocyte ratios that include monocytes as compared to the neutrophil-to-lymphocyte ratio (NLR) in aSAH. A prospectively accrued database of consecutive patients presenting to our institution with aSAH between January 2013 and December 2018 was used. Patients with signs and symptoms of infection (day 1-3) were excluded. Admission values of the NLR, monocyte-neutrophil-to-lymphocyte ratio (M-NLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. Associations with functional status, the primary outcome, and vasospasm were evaluated using univariable and multivariable logistic regression analyses. In the cohort of 234 patients with aSAH, the M-NLR and LMR, but not the NLR, were significantly associated with poor functional status (modified Rankin scale > 2) at 12-18 months following discharge (p = 0.001, p = 0.023, p = 0.161, respectively). The area under the curve for predicting poor functional status was significantly lower for the NLR (0.543) compared with the M-NLR (0.603, p = 0.024) and LMR (0.608, p = 0.040). The M-NLR (OR = 1.01 [1.01-1.02]) and LMR (OR = 0.88 [0.78-0.99]) were independently associated with poor functional status while controlling for age, hypertension, Fisher grade, and baseline clinical status. The LMR was significantly associated with vasospasm (OR = 0.84 [0.70-0.99]) while adjusting for age, hypertension, Fisher grade, aneurysm size, and current smoking. Inflammatory indices that incorporate monocytes (e.g., M-NLR and LMR), but not those that include only neutrophils, predict outcomes after aSAH.

摘要

特定免疫细胞群体对颅内破裂动脉瘤性蛛网膜下腔出血(aSAH)后炎症反应的贡献以及与临床结果(如血管痉挛和功能状态)的相关性尚不清楚。我们旨在比较包括单核细胞在内的白细胞比值与 aSAH 中性粒细胞与淋巴细胞比值(NLR)的预测价值。使用 2013 年 1 月至 2018 年 12 月期间我院连续就诊的 aSAH 患者的前瞻性累积数据库。排除有感染迹象和症状的患者(第 1-3 天)。计算 NLR、单核细胞-中性粒细胞与淋巴细胞比值(M-NLR)和淋巴细胞-单核细胞比值(LMR)的入院值。使用单变量和多变量逻辑回归分析评估与功能状态(主要结局)和血管痉挛的相关性。在 234 名 aSAH 患者的队列中,M-NLR 和 LMR,但不是 NLR,与出院后 12-18 个月的不良功能状态(改良 Rankin 量表>2)显著相关(p=0.001,p=0.023,p=0.161,分别)。预测不良功能状态的 NLR 曲线下面积明显低于 M-NLR(0.603,p=0.024)和 LMR(0.608,p=0.040)。在校正年龄、高血压、Fisher 分级和基线临床状态后,M-NLR(OR=1.01[1.01-1.02])和 LMR(OR=0.88[0.78-0.99])与不良功能状态独立相关。在校正年龄、高血压、Fisher 分级、动脉瘤大小和当前吸烟状况后,LMR 与血管痉挛显著相关(OR=0.84[0.70-0.99])。包含单核细胞的炎症指数(如 M-NLR 和 LMR),而不是仅包含中性粒细胞的炎症指数,可预测 aSAH 后的结果。

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