入院时中性粒细胞与淋巴细胞比值对腔隙性卒中患者早期神经功能恶化的预测价值  

Predictive value of neutrophil to lymphocyte ratio on admission for eariy neurological deterioration in patients with lacunar stroke

作　　者：张浩江[1] 葛中林[1] 钱明月[1] 陈皆春[1] 庄爱霞[1] Zhang Haojiang;Ge Zhonglin;Qian Mingyue;Chen Jiechun;Zhuang Aixia(Department of Neurology, the Second People's Hospital of Lianyungang, Lianyungang 222000, China)

机构地区：[1]连云港市第二人民医院神经内科,222000

出　　处：《国际脑血管病杂志》2019年第2期98-103,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨入院时中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对腔隙性卒中患者出现早期神经功能恶化(early neurological deterioration,END)的预测价值。方法回顾性纳入2015年6月至2017年10月在连云港市第二人民医院神经内科住院的急性腔隙性卒中患者。END定义为入院72h内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分增加M2分。应用多变量logistic回归分析确定影响END的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR对腔隙性卒中患者出现END的预测价值。结果共纳入309例腔隙性卒中患者,其中男性180例(58.2%),年龄(59.7±7.3)岁;END组65例(21.0%),非END组244例(79.0%).多变量logistic分析显示,在校正其他混杂因素后,NLR为腔隙性卒中出现END的独立危险因素(优势比4.508,95%可信区间3.128-7.547;P<0.001).ROC曲线分析显示,NLR预测腔隙性卒中患者发生END的曲线下面积为0.725(95%可信区间0.671~0.776;P<0.001);最佳截断值为2.32,预测END的敏感性为61.21%,特异性为72.54%。结论入院后NLR升高是腔隙性卒中患者岀现END的独立危险因素,对早期识别和预测END有一定的价值。Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) on admission for early neurological deterioration (END) in patients with lacunar stroke. Methods Patients with acute lacunar stroke admitted to the Department of Neurology, the Second People's Hospital of Lianyungang from June 2015 to October 2017 were enrolled retrospectively. END was defined as an increase of M2 in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission. Multivariate logistic regression analysis was used to determine the independent risk factors for END. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for END in patients with lacunar stroke. Results A total of 309 patients with acute lacunar infarction were enrolled, including 180 males (58. 2%), aged 59. 7 ± 7. 3 years;65 patients (21. 0%) in END group and 244 (79. 0%) in non- END group. Multivariate logistic regression analysis showed that after adjusting for other confounders, NLR was an independent risk factor for END in lacunar stroke (odds ratio 4. 508, 95% confidence interval 3. 128-7. 547;P <0. 001). ROC curve analysis showed that the area under the curve of NLR predicting END in patients with lacunar stroke was 0. 725 (95% confidence interval 0. 671-0. 776;P < 0. 001): the optimal cut-off value was 2.32, the sensitivity of predicting END was 61. 21 %, and the specificity was 72. 54%. Conclusion The elevated NLR after admission is an independent risk factor for END in patients with lacunar stroke, which has certain value for early identification and prediction of END.

关 键 词：卒中 腔隙 脑缺血 疾病恶化 中性粒细胞 淋巴细胞 白细胞计数 危险因素 生物标志物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]