中性粒细胞/淋巴细胞比值对急性大血管闭塞性卒中血管内治疗患者临床预后的影响  

Influence of neutrophil-to-lymphocyte ratio on clinical prognosis in acute large vessel occlusion stroke patients treated with endovascular treatment

作　　者：许向军 章宏传 许友清 徐骏峰 葛良[1] 杨科 黄显军[1] 杨倩[1] 周志明[1] Xu Xiangjun;Zhang Hongchuan;Xu Youqing;Xu Junfeng;Ge Liang;Yang Ke;Huang Xianjun;Yang Qian;Zhou Zhiming(Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241001,China;不详)

机构地区：[1]皖南医学院弋矶山医院神经内科,安徽省芜湖市241000 [2]皖南医学院弋矶山医院影像科,安徽省芜湖市241000

出　　处：《中国脑血管病杂志》2021年第1期3-10,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：皖南医学院中青年科研基金项目(WK2020F24)。

摘　　要：目的分析前循环急性大血管闭塞性卒中(ALVOS)早期血管内治疗(EVT)后24 h中性粒细胞/淋巴细胞比值(NLR)对患者发病后90 d临床预后的影响。方法连续序贯性地登记2015年7月至2019年8月就诊于皖南医学院弋矶山医院并接受了EVT的ALVOS患者;以发病后90 d改良Rankin量表(mRS)评估临床预后,以改良脑梗死溶栓(mTICI)分级评估术后闭塞血管再通情况,采用单因素及多因素Logistic回归分析探讨术后24 h NLR是否为患者发病后90 d预后的独立影响因素。根据受试者工作特征(ROC)曲线确定术后24 h NLR预测患者发病后90 d预后的最佳截断值,并分析可能导致术后24 h NLR升高的因素。结果最终共入组患者256例,男139例(54.3%),平均年龄(68±12)岁,中位基线Alberta卒中项目早期CT(ASPECT)评分8(8,10)分,中位基线美国国立卫生研究院卒中量表(NIHSS)评分16(13,19)分,其中预后良好组113例(44.1%),预后不良组143例(55.9%)。单因素分析结果显示,预后良好组患者术后24 h NLR明显低于预后不良组[(9±6)比(14±10),P<0.01];多元Logistic回归分析结果显示,术后24 h高NLR是影响发病后90 d临床预后的独立危险因素(OR=1.061,95%CI:1.016~1.109;P=0.008)。ROC曲线结果显示,EVT术后24 h NLR预测发病后90 d预后不良的临界值为6.97(曲线下面积是0.685,95%CI:0.620~0.750,敏感度83.2%,特异度46.0%);Spearman相关分析结果显示,术后24 h NLR与术前ASPECT评分、侧支循环丰富程度呈负相关(r=-0.169,P=0.007;r=-0.249,P<0.01),与入院NHISS评分、感染呈正相关(r=0.283,P<0.01;r=0.171,P=0.006)。结论对于接受EVT的ALVOS患者,EVT术后24 h NLR升高与发病后90 d临床预后不良相关,但术后24 h NLR对患者发病后90 d预后不良预测价值有限。术后24 h NLR增高可能与侧支循环不良、入院严重程度及感染具有一定的相关性。Objective To analysis the effects of neutrophil-to-lymphocyte ratio after 24 h(NLR 24 h)of the endovascular treatment(EVT)on 90-day clinical prognosis of patients with acute large vessel occlusion stroke(ALVOS)in anterior circulation.Methods From July 2015 to August 2019,ALVOS patients receiving EVT were consecutively recruited in Yijishan Hospital of Wannan Medical College.Functional outcome was assessed by the modified Rankin scale(mRS)at 90 days.The modified thrombolysis in cerebral infarction(mTICI)grading system was used for recanalization evaluation.The univariate and multivariate Logistic regression analysis were adopted to investigate whether NLR 24 h is an independent factor affecting patients′90-day prognosis.The receiver operating characteristic(ROC)curve was used to analyze the cut off value of NLR 24 h to predict patients′90-day prognosis.Then,the influencing factors leading to the elevation of the NLR 24 h were explored.Results A total of 256 patients were collected,including 139 males(54.3%)with the mean age of(68±12)years.The median baseline Albert stroke program early CT score(ASPECT)was 8(8,10);the median baseline National Institute of Health stroke scale(NIHSS)score was 16(13,19).There were 113 cases(44.1%)in the favorable prognosis group and 143 cases(55.9%)in the unfavorable prognosis group.Univariate analysis showed that the NLR 24 h of patients in favorable prognosis group was significantly lower than that of patients in unfavorable prognosis group([9±6]vs.[14±10],P<0.01).The multivariable Logistic regression analysis showed that the higher NLR 24 h was the independent risk factor of 90-day unfavorable prognosis.The ROC curve analysis showed that the optimal cut-off value of NLR 24 h to predict 90-day unfavorable prognosis was 6.97(AUC=0.685,95%CI 0.620-0.750;sensitivity 83.2%;specificity 46.0%).Spearman correlation analysis showed that the NLR 24 h was negatively correlated with pre-ASPECT and collateral circulation status(r=-0.169,P=0.007;r=-0.249,P<0.01),but was positively related

关 键 词：血管内治疗 急性缺血性卒中 中性粒细胞 淋巴细胞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]