摘要
目的 分析自发性脑出血（SICH）患者术后肺部感染的临床特点及风险因素，探讨中性粒细胞-淋巴细胞比值（NLR）和血小板-淋巴细胞比值（PLR）的变化，并构建预测列线图模型。方法 回顾性分析2024年9月—2025年6月收治的106例行手术治疗的SICH患者，根据是否发生术后肺部感染分为感染组和未感染组。比较两组临床资料，采用多因素Logistic回归筛选独立危险因素，并基于回归结果构建列线图，利用校准曲线、C-index和ROC曲线评估模型性能。结果 共26例发生肺部感染。与未感染组相比，感染组在年龄、糖尿病、发病至入院时间、GCS ≤ 8分、气管切开、开颅手术、血清葡萄糖、NLR3及PLR3方面差异显著（P＜0.05）。多因素分析显示，年龄、气管切开、开颅手术、NLR3和PLR3为独立危险因素（P＜0.05）。NLR3和PLR3预测肺部感染的AUC分别为0.734和0.741；列线图模型AUC为0.938，Bootstrap验证校准良好（P＞0.05），C-index为0.903。结论 NLR3和PLR3是SICH术后肺部感染的独立危险因素。基于其构建的列线图具有良好预测性能，可用于临床风险评估。
关键词： 脑出血；肺部感染；免疫炎症指数
Abstract
Objective To analyze the clinical characteristics and risk factors of postoperative pulmonary infection in patients with ICH, evaluate changes in the NLR and PLR, and establish a predictive nomogram. Methods A retrospective analysis was conducted on 106 surgically treated SICH patients admitted between September 2024 and June 2025. Patients were divided into infection and non-infection groups according to postoperative pulmonary infection. Clinical data were compared, and independent risk factors were identified using multivariate logistic regression. A nomogram was constructed based on these factors and validated using calibration curves, the C-index, and ROC curves. Results Postoperative pulmonary infection occurred in 26 patients. Compared with the non-infection group, the infection group showed significant differences in age, diabetes, onset-to-admission time, GCS ≤ 8, tracheotomy, craniotomy, serum glucose, NLR3, and PLR3 (P < 0.05). Multivariate analysis identified age, tracheotomy, craniotomy, NLR3, and PLR3 as independent risk factors (P < 0.05). The AUCs of NLR3 and PLR3 for predicting pulmonary infection were 0.734 and 0.741, respectively. The nomogram achieved an AUC of 0.938, with good calibration in bootstrap validation (P > 0.05) and a C-index of 0.903. Conclusion NLR3 and PLR3 are independent risk factors for postoperative pulmonary infection in SICH patients. The nomogram based on these factors demonstrates strong predictive performance and may assist in clinical risk assessment.
Key words： Intracerebral hemorrhage; Lung infection; Immune-inflammatory index
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