NLR、PLR、LMR等炎症标志物与原发性脑干出血患者预后的相关性研究

Correlation of inflammatory markers including NLR, PLR, and LMR with prognosis in patients with primary brainstem hemorrhage

摘要:

目的 探讨中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和淋巴细胞-单核细胞比值（LMR）与原发性脑干出血（PBH）患者预后的相关性，为临床预后评估提供新的指标。方法 回顾性分析2022年1月至2024年12月贵阳市第二人民医院收治的177例PBH患者的临床资料，包括人口学特征、血常规指标、影像学表现、治疗方式及3个月随访结果。计算NLR、PLR和LMR，采用格拉斯哥预后评分（GOS）评估预后，分为预后良好组（GOS 4-5分）和预后不良组（GOS 1-3分）。通过单因素分析和Logistic回归分析探讨炎症标志物与预后的相关性。结果 177例患者中，预后良好83例（46.9%），预后不良94例（53.1%）。单因素分析显示，入院GCS评分、血肿量、治疗方式、NLR、PLR和LMR等因素与预后不良显著相关（P<0.05）。多因素Logistic回归分析表明，NLR是PBH预后不良的独立危险因素（OR=14.724, 95%CI: 5.164-41.981, P<0.001），入院GCS评分（OR=0.688, 95%CI: 0.605-0.782, P<0.001）和机器人辅助手术（OR=0.007, 95%CI: 0.001-0.094, P<0.001）是保护性因素。PLR和LMR在多因素分析中未显示独立预测价值。结论 NLR与PBH预后密切相关，是预后不良的独立危险因素。PLR和LMR虽在单因素分析中与预后相关，但在多因素分析中未被确认为独立影响因素。机器人辅助手术可能通过减少炎症反应改善预后。

Abstract:

Objective To investigate the correlation of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) with the prognosis of patients with primary brainstem hemorrhage (PBH), and to provide new indicators for clinical prognostic evaluation. Methods A retrospective analysis was conducted on the clinical data of 177 PBH patients admitted to the Second People's Hospital of Guiyang from January 2022 to December 2024, including demographic characteristics, hematological parameters, imaging findings, treatment modalities, and 3-month follow-up outcomes. NLR, PLR, and LMR were calculated, and prognosis was assessed using the Glasgow Outcome Scale (GOS), with patients categorized into good prognosis (GOS 4-5) and poor prognosis (GOS 1-3) groups. Univariate analysis and multivariate logistic regression were performed to explore the association between inflammatory markers and prognosis. Results Among the 177 patients, 83 (46.9%) had a good prognosis, and 94 (53.1%) had a poor prognosis. Univariate analysis revealed that admission Glasgow Coma Scale (GCS) score, hematoma volume, treatment modality, NLR, PLR, and LMR were significantly associated with poor prognosis (P<0.05). Multivariate logistic regression analysis identified NLR as an independent risk factor for poor prognosis in PBH (OR=14.724, 95%CI: 5.164-41.981, P<0.001), while admission GCS score (OR=0.688, 95%CI: 0.605-0.782, P<0.001) and robot-assisted surgery (OR=0.007, 95%CI: 0.001-0.094, P<0.001) were protective factors. PLR and LMR showed no independent prognostic value in multivariate analysis. Conclusion ?NLR is closely associated with PBH prognosis and serves as an independent risk factor for poor outcomes, making it a potential new indicator for clinical prognostic evaluation. Although PLR and LMR were associated with prognosis in univariate analysis, they were not confirmed as independent predictors in multivariate analysis. Robot-assisted surgery may improve prognosis by reducing inflammatory responses, warranting further investigation.