目的 研究中性粒细胞/淋巴细胞比值(NLR)对新生儿缺氧缺血性脑病(HIE)早期分度诊断的价值。方法 收集兰州大学第二医院新生儿科HIE病例134例,其中轻度HIE组42例,中重度HIE组36例,正常对照组56例。内容包括患儿一般资料,出生分娩情况,第1、3、7天血常规,计算NLR和血小板/淋巴细胞比值(PLR),生后1周内行头颅MRI检查,采用单因素分析、受试者工作特征曲线(ROC)及Kappa一致性检验判断进行统计学分析。结果 单因素分析显示,第1天和第3天白细胞、中性粒细胞、NLR是中重度HIE组的危险因素,第1天中重度HIE组NLR较同期正常对照组明显升高(5.55±1.88 vs 2.63±0.91,P<0.05),轻度HIE组NLR升高不明显(2.71±0.92 vs 2.63±0.91,P>0.05),中重度HIE组NLR明显高于轻度HIE组(5.55±1.88 vs 2.71±0.92,P<0.05);ROC曲线显示第1天NLR效能最高(曲线下面积达0.959),灵敏度高达93.3%,特异度达81.0%,最佳截断点为3.43;Kappa检验显示NLR与1周内头颅MRI结果基本一致。结论 新生儿窒息1周内NLR对HIE早期分度诊断具有一定预测价值。
Abstract
Objective To investigate the value of neutrophil to lymphocyte ratio (NLR) in early grading diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). Methods A total of 134 cases were collected in Lanzhou University Second Hospital and were divided into three groups:the mild HIE group (n=42),the moderate and severe HIE group (n=36),and the normal control group (n=56).It was included neonatal general information,birth situation,blood cell count on 1st day,3rd and 7th day,and calculating NLR and platelet to lymphocyte ratio (PLR).The cranial magnetic resonance imaging (MRI) was scaned in the time of 1st week after birth.Univariate factor analysis,receiver operating characteristic curve (ROC curve) and Kappa consistency analysis were used to determine the NLR value. Results Univariate analysis showed that white blood cells count,neutrophils count and NLR levels on 1st day and 3rd day were the risk factors in the moderate and severe HIE group.Compared with the normal controls,NLR levels on 1st day of the moderate and severe HIE patients increased significantly (5.55±1.88 vs 2.63±0.91,P<0.05),relatively,that of the mild HIE patients increased slightly (2.71±0.92 vs 2.63±0.91,P>0.05).The levels of NLR in the moderate and severe HIE group was significantly higher than that of the mild HIE group (5.55±1.88 vs 2.71±0.92,P<0.05);ROC curve showed the efficiency of NLR on 1st day(area under the curve up to 0.959) was the highest with sensitivity of 93.3%,specificity of 81.0% and the optimal cut-off value was 3.43;Kappa analysis showed that the Results of NLR were consistent with that of cranial MRI in 1st week after birth. Conclusion NLR has a certain predictive value for the early grading diagnosis of HIE after asphyxia.
关键词
新生儿缺氧缺血性脑病 /
中性粒细胞/淋巴细胞比值 /
诊断
Key words
hypoxic ischemic encephalopathy /
neutrophil to lymphocyte ratio /
diagnosis.
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