动脉瘤性蛛网膜下腔出血患者外周血白细胞计数与病情严重程度的相关性分析

摘要

Objective To study the relationship between peripheral leukocyte differential counts at admission and the degree of severity in patients with aneurysmal subarachnoid hemorrhage (aSAH) ,and compare their values in evaluating the severity .Meth‐ods A total of 180 patients with aSAH were divided into high and low Hunt‐Hess grades according to the severity of the disease . At the same time ,the patients were also graded to the severe group and moderate group according to Glasgow coma scales (GCS) . The relationship between peripheral leucocyte differential counts and the severity was analyzed ,and receiver operating characteris‐tics (ROC) was drawn to evaluate the ability of the WBC differential counts in distinguishing different levels of severity .Results Compared with those of patients with low Hunt‐Hess grade and moderate GCS ,WBC ,absolute neutrophil count and percentage of neutrophil in high Hunt‐Hess grade and severe GCS were significantly higher(P<0 .05) ,while percentage of lymphocyte was lower (P<0 .05) .WBC and absolute neutrophil count were positively correlated with Hunt‐Hess grade(r=0 .516 ,P=0 .000;r=0 .527 , P=0 .000) and negatively correlated with GCS (r= -0 .508 ,P=0 .000;r= -0 .514 ,P=0 .000) .Percentage of neutrophil and per‐centage of lymphocyte were weakly correlated with Hunt‐Hess grade and GCS .ROC analysis indicated that the best indicators for judging the severity were WBC and absolute neutrophil count ,and the cut‐off values of the two indicators for high Hunt‐Hess grade were 12 .21 × 109/L and 10 .14 × 109/L ,which for severe GCS were 15 .10 × 109/L and 13 .55 × 109/L ,respectively . Conclusion WBC and absolute neutrophil count are the equivalent and best indicators in distinguishing the degree of severity .Com‐bination of clinical scales ,WBC and absolute neutrophil count might help to make a more accurate diagnosis of the degree of severity in patients with aSAH .%目的：比较动脉瘤性蛛网膜下腔出血（aSAH）患者白细胞总数（WBC）及分类计数在判断aSAH患者病情严重程度中的临床价值。方法180例aSAH患者依病情严重程度按Hunt‐Hess级分为高级别、低级别，按格拉斯哥昏迷评分（GCS）分为轻中型、重型。分析入院时WBC及分类与该两个临床分级的相关性。绘制受试者工作特征（ROC ）曲线，评价WBC及分类计数鉴别病情严重的能力。结果分别与Hunt‐Hess低级别和GCS轻中型相比，Hunt‐Hess高级别和GCS重型的WBC、中性粒细胞绝对值、中性粒细胞百分比显著升高，淋巴细胞百分比则均降低，差异均有统计学意义（P＜0．05）。WBC、中性粒细胞绝对值与Hunt‐Hess分级较强正相关（r＝0．516，P＝0．000；r＝0．527，P＝0．000），与 GCS 较强负相关（r＝－0．508，P＝0．000；r＝－0．514，P＝0．000），而中性粒细胞百分比、淋巴细胞百分比与该两个临床分级弱相关。ROC曲线分析显示判断病情严重程度的最佳指标为WBC和中性粒细胞绝对值；该二者判断Hunt‐Hess高级别的截点值分别为12．21×109／L、10．14×109／L ；判断GCS重型的截点值分别为15．10×109／L、13．55×109／L。结论 aSA H患者入院时WBC、中性粒细胞绝对值判断病情严重程度价值相当且最佳。临床量表联合WBC和中性粒细胞绝对值有助于更可靠地准确评估aSA H病情严重程度。