文章摘要
洪健,侯景明,程成,陈辉,段霞,刘宏亮.中性粒细胞/淋巴细胞比值在评估早期脊髓损伤严重程度中的应用研究[J].中国康复,2022,37(6):323-326
中性粒细胞/淋巴细胞比值在评估早期脊髓损伤严重程度中的应用研究
Application of neutrophil to lymphocyte ratio in assessing the severity of early spinal cord injury
  
DOI:
中文关键词: 脊髓损伤  中性粒细胞/淋巴细胞比值  早期评估
英文关键词: Spinal cord injury  Neutrophil to lymphocyte ratio  Early assessment
基金项目:国家自然科学基金项目(82172542);重庆市自然科学基金项目(cstc2021jcyj-msxmX0612)
作者单位
洪健 陆军军医大学西南医院康复医学科重庆 400038 
侯景明 陆军军医大学西南医院康复医学科重庆 400038 
程成 陆军军医大学西南医院康复医学科重庆 400038 
陈辉 陆军军医大学西南医院康复医学科重庆 400038 
段霞 陆军军医大学西南医院康复医学科重庆 400038 
刘宏亮 陆军军医大学西南医院康复医学科重庆 400038 
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中文摘要:
  目的:探讨脊髓损伤(SCI)患者入院首次外周血中性粒细胞与淋巴细胞比值(NLR)对其损伤严重程度的早期评估作用。方法:回顾性分析2010年6月至2021年1月由陆军军医大学附属西南医院急诊收入并转入康复科住院治疗的SCI患者62例,根据伤后ASIA损伤分级将纳入患者分为完全性运动损伤组(ASIA损伤分级A级或B级)35例,不完全性运动损伤组(ASIA损伤分级C级、D级)27例。收集2组患者的临床资料及实验室检验资料,根据入院时中性粒细胞计数、淋巴细胞计数计算NLR,应用单因素分析比较2组间资料差异,应用多因素Logistic回归分析完全性运动损伤的可能危险因素,利用受试者工作特征(ROC)曲线下面积评估各指标的评估能力。结果:完全性运动损伤组患者的入院后首次NLR值水平显著高于不完全性运动损伤组(P<0.05),淋巴细胞计数水平明显低于不完全性运动损伤组(P<0.01)。多因素Logistic回归分析显示,调整混杂因素后,淋巴细胞计数水平升高是脊髓损伤后完全性运动损伤的独立保护因素(OR=0.211,95%CI:0.051~0.878,P<0.05)。NLR值的曲线下面积为0.726 (95%CI:0. 598~0. 854,P<0.05),当截断值为9.711时,有最大约登指数0.398,其敏感度为65.71%,特异度为74.07%;淋巴细胞计数的曲线下面积为0.740 (95%CI:0.610~0.870,P<0.05),当截断值为1.220时,有最大约登指数0.461,其敏感度为94.29%,特异度为51.85%;二者联合的曲线下面积为0.751(95%CI: 0.625~0.878,P<0.05)。结论:入院后首次NLR值作为简单、便宜、容易获得的检验指标,可能对早期SCI严重程度有一定评估价值。
英文摘要:
  Objective: To investigate the function of the peripheral blood neutrophil to lymphocyte ratio (NLR) at initial admission in the early assessment of injury severity in patients with spinal cord injury (SCI). Methods: A total of 62 patients with SCI admitted to the Emergency Department of Southwest Hospital of Army Medical University then transferred to the Department of Rehabilitation Medicine from June 2010 to January 2021 were analyzed retrospectively. According to the ASIA Impairment Scale, the included patients were dichotomized into either the complete motor function injury group (ASIA Impairment Scale A and B, n=35) and the incomplete motor function injury group (ASIA Impairment Scale C and D, n=27). The clinical data and laboratory test data of the two groups were collected, and NLR was calculated according to the neutrophil count and lymphocyte count at admission. The univariate analysis was used to compare the data differences between the two groups, the multivariate Logistic regression was used to analyze the possible risk factors of complete motor function injury, and the evaluation ability of each index was evaluated by the area under the receiver operating characteristic (ROC) curve. Results: The NLR at initial admission in the complete motor function injury group was significantly higher than that in the incomplete mo-tor function injury group (P<0.05), and the lymphocyte count was significantly lower in the complete motor function injury group than that in the incomplete motor function injury group (P<0.01). The results of multivariate Logistic regression analysis showed that the increase of lymphocyte count was an independent protec-tive factor for complete motor function injury after adjusting for confounding factors (OR=0.211, 95%CI: 0.051-0.878, P<0.05). The area under the ROC curve of NLR was 0.726 (95%CI: 0. 598-0.854, P<0.05). When the cut-off value was 9.711, the maximum Youden index was 0.398, its sensitivity was 65.71% and specificity was 74.07%. The area under the ROC curve of lymphocyte count was 0.740 (95%CI: 0.610-0.870, P<0.05). When the cut-off value was 1.220, the maximum Youden index was 0.461, the sensitivity was 94.29% and specificity was 51.85%. The area under the ROC curve of the combination of NLR and lymphocyte count was 0.751 (95%CI: 0.62500.878, P<0.05). Conclusion: As simple, cheap and easily available, the NLR at initial admission may have a certain value in evaluating the severity of early SCI.
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