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中华脑血管病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (05) : 549 -555. doi: 10.3877/cma.j.issn.1673-9248.2026.05.010

临床研究

术前中性粒细胞与淋巴细胞比值预测高血压基底节区脑出血患者临床预后的价值
黄宝辰, 徐晓晓, 柏明涛, 苏庚, 刘海涛†()   
  1. 276826 山东日照,日照市人民医院神经外科
  • 出版日期:2026-10-01
  • 通信作者: 刘海涛

Value of preoperative neutrophil-to-lymphocyte ratio in predicting the clinical prognosis in patients with hypertensive basal ganglia cerebral hemorrhage

Baochen Huang, Xiaoxiao Xu, Mingtao Bai, Geng Su, Haitao Liu†()   

  1. Department of Neurosurgery, People's Hospital of Rizhao, Rizhao 276826, China
  • Published:2026-10-01
  • Corresponding author: Haitao Liu
引用本文:

黄宝辰, 徐晓晓, 柏明涛, 苏庚, 刘海涛. 术前中性粒细胞与淋巴细胞比值预测高血压基底节区脑出血患者临床预后的价值[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(05): 549-555.

Baochen Huang, Xiaoxiao Xu, Mingtao Bai, Geng Su, Haitao Liu. Value of preoperative neutrophil-to-lymphocyte ratio in predicting the clinical prognosis in patients with hypertensive basal ganglia cerebral hemorrhage[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(05): 549-555.

目的

分析术前中性粒细胞与淋巴细胞比值(NLR)和高血压基底节区脑出血(HBGCH)患者术后30 d临床预后的关系。

方法

回顾性收集2020年1月至2022年12月日照市人民医院神经外科收治的HBGCH患者的临床数据及预后资料。根据术后30 d改良Rankin 量表(mRS)评分将患者分为预后良好组(mRS评分0~2分)和预后不良组(mRS评分3~6分)。分析HBGCH患者术前NLR和临床转归的相关性,应用多因素Logistic回归分析建立预测模型。通过受试者操作特征(ROC)曲线分析术前NLR的预测价值。

结果

最终纳入178例患者,其中男性124例(69.66%),女性54例(30.34%),平均年龄(56.06±12.15)岁。预后良好组患者73例,预后不良组患者105例。多因素Logistic回归分析结果显示:格拉斯哥昏迷评分(GCS;OR=0.687,95%CI:0.581~0.813,P<0.001)、出血量(OR=1.028,95%CI:1.007~1.050,P=0.011)和NLR(OR=1.163,95%CI:1.078~1.254,P<0.001)均与HBGCH患者预后独立相关。患者术前NLR预测HBGCH术后短期预后不良的AUC为0.726(95%CI:0.651~0.800,P<0.001),最佳截断值为9.52,敏感度为65.7%,特异度为78.1%。

结论

术前NLR是HBGCH患者术后30 d临床预后不良的独立危险因素,术前NLR升高预示结局不良。

Objective

To analyze the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and postoperative 30-day prognosis in patients with hypertensive basal ganglia cerebral hemorrhage (HBGCH).

Methods

The clinical data and prognostic data of patients with HBGCH admitted to the Department of Neurosurgery of People's Hospital of Rizhao from January 2020 to December 2022 were retrospectively collected and analyzed. According to the modified Rankin scale (mRS) score 30-day after surgery, the patients were divided into good prognosis group (mRS score 0-2) and poor prognosis group (mRS score 3-6). The correlation between the preoperative NLR and clinical outcome in HBGCH patients was analyzed, and the prediction model was established by multivariate Logistic regression analysis. The predictive value of preoperative NLR was analyzed by receiver operating characteristic (ROC) curve.

Results

A total of 178 patients were included, including 124 males (69.66%) and 54 females (30.34%), with an average age of (56.06±12.15) years. There were 73 patients in the good prognosis group and 105 in the poor prognosis group. Multivariate Logistic regression analysis showed that Glasgow coma scale (GCS; OR=0.687, 95%CI: 0.581 to 0.813, P<0.001), hematoma volume (OR=1.028, 95%CI: 1.007 to 1.050, P=0.011) and NLR (OR=1.163, 95%CI: 1.078 to 1.254, P<0.001) were independently associated with patient prognosis. The AUC of the preoperative NLR in predicting the short-term poor prognosis after HBGCH surgery was 0.726 (95%CI: 0.651 to 0.800, P<0.001). The optimal cut-off value was 9.52, with a sensitivity of 65.7% and a specificity of 78.1%.

Conclusion

Preoperative NLR is an independent risk factor for postoperative 30-day adverse prognosis in patients with hypertensive basal ganglia cerebral hemorrhage, and preoperative NLR elevation predicts poor outcome.

表1 2组高血压基底节区脑出血患者基线资料比较
临床资料 预后良好组(n=73) 预后不良组(n=105) 统计值 P值
性别[例(%)] χ2=0.378 0.539
男性 49(67.12) 75(71.43)
女性 24(32.88) 30(28.57)
年龄(年,
±s)
53.56±11.49 57.79±12.36 t=2.311 0.022
BMI(kg/m2,
±s)
26.77±3.77 25.74±3.20 t=1.896 0.060
吸烟[例(%)] 16(21.92) 28(26.67) χ2=0.522 0.470
饮酒[例(%)] 17(23.29) 30(28.57) χ2=0.619 0.432
糖尿病[例(%)] 11(15.07) 7(6.67) χ2=3.344 0.067
收缩压(mmHg,
±s)
171.30±24.43 174.30±24.67 t=1.713 0.076
舒张压[mmHg,M(Q1,Q3)] 98.00(89.50,105.00) 100.00(87.50,112.50) Z=1.220 0.222
心率(次/分,
±s)
80.11±16.85 84.34±18.93 t=1.534 0.127
体温(℃,
±s)
36.91±0.64 37.01±0.83 t=0.834 0.405
ICU住院时间[d,M(Q1,Q3)] 1.00(0,3.50) 5.00(1.00,11.50) Z=4.423 <0.001
总住院时间[d,M(Q1,Q3)] 15.00(12.00,20.00) 17.00(12.00,27.00) Z=1.565 0.118
GCS(分,
±s)
11.14±2.57 7.94±2.92 t=7.534 <0.001
手术方式[例(%)] χ2=0.217 0.642
开颅血肿清除术 66(90.41) 97(92.38)
置管血肿引流术 7(9.59) 8(7.62)
出血破入脑室[例(%)] 28(35.36) 60(57.14) χ2=6.080 0.014
出血量(mL,
±s)
49.04±17.43 67.86±24.37 t=5.664 <0.001
术后再出血手术[例(%)] 2(2.74) 8(7.62) χ2=1.933 0.201
白细胞(×109 /L,
±s)
10.16±3.68 13.69±1.11 t=5.441 <0.001
单核细胞(×109 /L,
±s)
0.53±0.30 0.61±0.32 t=1.829 0.069
中性粒细胞(×109 /L,
±s)
8.00±3.52 11.64±4.63 t=5.672 <0.001
淋巴细胞(×109 /L,
±s)
1.52±0.88 1.36±1.11 t=1.052 0.294
血红蛋白[g/L,M(Q1,Q3)] 146.00(134.50,160.00) 144.00(130.50,155.00) Z=1.358 0.175
血小板[×109 /L,M(Q1,Q3)] 196.00(160.00,254.50) 212.00(183.50,247.00) Z=1.171 0.242
NLR(
±s)
7.06±5.03 12.61±7.91 t=5.300 <0.001
D-二聚体[µg/L,M(Q1,Q3)] 360.00(230.00,590.00) 400.00(280.00,720.00) Z=1.388 0.165
白蛋白[g/L,M(Q1,Q3)] 39.79(37.19,43.40) 37.91(34.55,42.40) Z=2.336 0.019
肌酐(µmol/L,
±s)
65.76±21.96 73.46±29.29 t=1.905 0.058
甘油三酯(mmol/L,
±s)
1.13±0.66 1.01±0.67 t=1.268 0.207
血钾(mmol/L,
±s)
3.86±0.51 3.76±0.56 t=1.191 0.235
血钠[mmol/L,M(Q1,Q3)] 140.20(137.00,142.38) 140.00(136.90,142.15) Z=0.742 0.458
血糖(mmol/L,
±s)
8.02±2.83 9.06±3.20 t=2.234 0.027
表2 单因素和多因素Logistic回归分析筛选高血压基底节区脑出血患者术后30 d预后不良的影响因素
表3 不同影响因素对高血压基底节区脑出血患者术后30 d预后不良的预测价值
图1 出血量(图a)、中性粒细胞与淋巴细胞比值(NLR;图b)和格拉斯哥昏迷评分(GCS;图c)预测高血压基底节区脑出血患者预后不良的受试者操作特征曲线
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