中性粒细胞/淋巴细胞比值预测急性缺血性卒中患者的出血性转化  

Neutrophil to lymphocyte ratio predicts hemorrhagic transformation in patients with acute ischemic stroke

作　　者：蓝文雅[1] 邱峰[1] 张尧[1] 姜海波[1] 杜明洋[1] 许丽丽 曹辉[1] Lan Wenya;Qiu Feng;Zhang Yao;Jiang Haibo;Du Mingyang;Xu Lili;Cao Hui(The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院,210029

出　　处：《国际脑血管病杂志》2021年第8期583-588,共6页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(82001260);南京医科大学科技发展基金(NMUB2018199)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio, NLR)对急性缺血性卒中(acute ischemic stroke, AIS)患者出血性转化(hemorrhagic transformation, HT)的预测价值。方法连续纳入2015年12月至2020年12月期间南京医科大学附属南京脑科医院脑血管病救治中心收住的未进行静脉溶栓和机械血栓切除的AIS患者。收集患者临床、影像学和实验室检查资料。HT定义为AIS患者首次影像学检查未发现出血征象,但住院后影像学复查发现颅内出血。应用多变量logistic回归分析确定NLR与HT的独立相关性,应用受试者工作特征曲线分析NLR对HT的预测价值。结果共纳入805例AIS患者,中位年龄67岁(四分位数间距63~71岁),中位美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分4分(四分位数间距2~9分),中位NLR为3.84(四分位数间距2.66~5.30),72例(8.9%)患者发生HT。HT组与无HT组年龄、基线收缩压、基线NIHSS评分、发病至入院时间、发病至采血时间、发病至影像学复查时间、NLR以及心房颤动、既往卒中和短暂性脑缺血发作史和卒中病因学分型的患者比例差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,校正混杂因素后,NLR是AIS患者发生HT的独立危险因素(优势比1.355,95%置信区间1.099~1.672;P=0.005)。受试者工作特征曲线分析显示,NLR预测HT的曲线下面积为0.852,最佳截断值为4.75,其预测HT的敏感性和特异性分别为83.3%和71.8%。结论高NLR是AIS患者住院期间发生HT的独立危险因素,且对HT风险具有较好的预测价值。Objective To investigate the predictive value of neutrophil to lymphocyte ratio(NLR)for hemorrhagic transformation(HT)in patients with acute ischemic stroke(AIS).Methods Consecutive patients with AIS without performing intravenous thrombolysis and mechanical thrombectomy admitted to the Cerebrovascular Disease Treatment Center,the Affiliated Brain Hospital of Nanjing Medical University from December 2015 to December 2020 were enrolled.The clinical,imaging and laboratory examination data were collected.HT was defined as the first imaging examination of AIS patients without finding bleeding signs,but the imaging reexamination after hospitalization found intracranial hemorrhage.Multivariate logistic regression analysis was used to determine the independent correlation between NLR and HT.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR for HT.Results A total of 805 patients with AIS were included.The median age was 67 years(interquartile range,63-71 years),the median National Institutes of Health Stroke Scale(NIHSS)score was 4(interquartile range,2-9),the median NLR was 3.84(interquartile range,2.66-5.30).Seventy-ywo patients(8.9%)had HT.There were significant differences in age,baseline systolic blood pressure,baseline NIHSS score,time from onset to admission,time from onset to blood collection,time from onset to imaging reexamination,NLR,atrial fibrillation,history of previous stroke and transient ischemic attack and stroke etiology between the HT group and the non-HT group(all P<0.05).Multivariate logistic regression analysis showed that NLR was an independent risk factor for HT in patients with AIS after adjusting for confounding factors(odds ratio 1.355,95%confidence interval 1.099-1.672;P=0.005).The ROC curve analysis showed that the area under the curve of NLR predicting HT was 0.852,and the optimal cut-off value was 4.75.Its sensitivity and specificity of predicting HT were 88.3%and 71.8%respectively.Conclusion High NLR is an independent risk factor for HT in pat

关 键 词：卒中 脑缺血 颅内出血 中性粒细胞 淋巴细胞 危险因素 试验预期值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]