摘要
目的探讨血小板/淋巴细胞比值(PLR)联合血栓弹力图(TEG)血栓最大振幅(MA)值预测急性颅脑损伤预后的价值。方法对90例急性颅脑损伤患者(脑损伤组)和50例健康体检者(对照组)进行血小板(PLT)、白细胞计数、凝血功能和血栓弹力图(TEG)检查。脑损伤组患者伤后6个月时采用格拉斯哥预后量表(GOS)评分评估其预后。PLR、MA值与患者预后的相关性采用Pearson相关分析;PLR和MA值预测预后的效能用ROC曲线分析。结果脑损伤组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均显著高于对照组,纤维蛋白原(Fib)显著低于对照组,差异均有统计学意义(均P_(PT)=0.000,P_(APTT)=0.000,P_(Fib)=0.000);脑损伤组的中性粒细胞/淋巴细胞计数(NLR)、PLR、凝血反应时间(R值)、凝血形成时间(K值)、凝血指数(CI)均显著高于对照组,PLT计数、凝固角(α角)、MA值均显著低于对照组,差异均有统计学意义(P_(R值)=0.000,P_(NLR)=0.000,P_(PLR)=0.012,P_(K值)=0.000,P_(PLT)=0.000,P_(α)=0.000,P_(MA值)=0.000,P_(CI)=0.025)。脑损伤组患者中预后不良患者的NLR、PLR、R值、K值、CI均显著高于预后良好患者,PLT计数、α、MA值均显著低于预后良好组,差异均有统计学意义(P_(R值)=0.000,P_(NLR)=0.000,P_(PLR)=0.000,P_(K值)=0.000,P_(PLT)=0.002,P_(α)=0.000,P_(MA值)=0.000,P_(CI)=0.000)。脑损伤组患者的PLR、CI、R值、K值与格拉斯哥昏迷量表(GCS)和GOS评分均呈负相关(GCS:r_(PLR)=-0.304,P_(PLR)=0.006,r_(R)=-0.452,P_(R)=0.004,r_(K)=-0.241,P_(K)=0.033,r_(CI)=-0.416,P_(CI)=0.010;GOS:r_(PLR)=-0.421,P_(PLR)=0.008,r_(R)=-0.504,P_(R)=0.023,r_(K)=-0.316,P_(K)=0.009,r_(CI)=-0.486,P_(CI)=0.011),MA值、α与GCS和GOS评分均呈正相关(GCS:r_(MA)=0.341,P_(MA)=0.016,r_(α)=0.358,P_(α)=0.007;GOS:r_(MA)=0.467,P_(MA)=0.012,r_(α)=0.411,P_(α)=0.003)。MA值、PLR预测预后的ROC曲线下面积(AUC)分别为0.761、0.937,而两者联合预测的AUC为0.979。结论PLR和TEG各指标可反映急性颅脑损伤患者的凝血功能及炎症状态;PLR联合MA值可预测患者的预后,对指导颅脑损伤的治疗有重要价值。
Objective To investigate the value of platelet/lymphocyte ratio(PLR)combined with maximum amplitude of thrombus(MA)in the prognosis of acute craniocerebral injury.Methods 90 patients with acute brain injury were selected as the observation group,while 50 healthy people were selected as the control group before treatment.Venous blood of elbow was collected on an empty stomach,and blood of control group was collected during physical examination to detect platelet count,white blood cell count,coagulation function and thromboelastography(TEG).The levels of each index in the two groups were compared,and the correlation between PLR,Ma value and prognosis of acute craniocerebral injury was analyzed.Results The prothrombin time(PT)and activated partial thromboplastin time(APTT)of the observation group were significantly higher than those of the control group,and the fibrinogen(FIB)of the observation group was significantly lower than that of the control group(P_(PT)=0.000,P_(APTT)=0.000,P_(Fib)=0.000).The neutrophil/lymphocyte count(NLR),platelet count/lymphocyte count(PLR),coagulation reaction time(R value),coagulation formation time(K value)and coagulation index(CI)of the observation group were significantly higher than those of the control group,while the platelet count(PLT),coagulation angle(αangle)and maximum amplitude of thrombosis(MA value)of the observation group were significantly lower than those of the control group,with statistical significance(P_(R value)=0.000,P_(NLR)=0.000,P_(PLR)=0.012,P_(K value)=0.000,P_(PLT)=0.000,P_(α)=0.000,P_(MA value)=0.000,P_(CI)=0.025).In the observation group,NLR,PLR,R value,K value,Ci of patients with poor prognosis were significantly higher than those of patients with good prognosis.PLT,α,Ma value were significantly lower than those of patients with good prognosis,the difference was statistically significant(P_(R value)=0.000,P_(NLR)=0.000,P_(PLR)=0.000,P_(K value)=0.000,P_(PLT)=0.002,P_(α)=0.000,P_(MA value)=0.000,P_(CI)=0.000).Pearson correlation analysis showed that PLR,CI,R value and K value were negatively correlated with GCS score and GOS score(GCS:r_(PLR)=-0.304,P_(PLR)=0.006,r_(R)=-0.452,P_(R)=0.004,r_(K)=-0.241,P_(K)=0.033,r_(CI)=-0.416,P_(CI)=0.010,GOS:r_(PLR)=-0.421,P_(PLR)=0.008,r_(R)=-0.504,P_(R)=0.023,r_(K)=-0.316,P_(K)=0.009,r_(CI)=-0.486,P_(CI)=0.011),MA value andαwere positively correlated with GCS and GOS score,and the difference was statistically significant(GCS:r_(MA)=0.341,P_(MA)=0.016,r_(α)=0.358,P_(α)=0.007,;GOS:r_(MA)=0.467,P_(MA)=0.012,r_(α)=0.411,P_(α)=0.003).The area under the ROC curve of MA value and PLR was 0.761 and 0.937 respectively,and the area under the ROC curve of combined prediction of MA value and PLR was 0.979.Conclusion PLR and TEG test can reflect the coagulation state and inflammatory state of patients with craniocerebral injury,and can be used to evaluate the prognosis of patients,which has important guiding significance for the treatment of craniocerebral injury.However,in clinical work,it is still necessary to check the traditional coagulation function,comprehensively evaluate the coagulation state and comprehensively evaluate the prognosis.
作者
王松
苏菲
李士雪
郑勇涛
王敏
WANG Song;SU Fei;LI Shi-xue(Department of Neurosurgery, Xingtai Third Hospital, Xingtai 054000, China)
出处
《临床神经外科杂志》
CAS
2021年第2期191-195,共5页
Journal of Clinical Neurosurgery
