中性粒细胞/淋巴细胞比值对多发性急性脑梗死患者Trousseau综合征的预测价值  

Predictive value of neutrophil-lymphocyte ratio for Trousseau’s syndrome in patients with acute multiple cerebral infarctions

作　　者：于乐林 尚海龙[1] 杜红娣[1] 王莺[1] 王一超[1] 徐长贺 李振凯[1] 赵世伟 郑芳慧 沈海林[1] Yu Lelin;Shang Hailong;Du Hongdi;Wang Ying;Wang Yichao;Xu Changhe;Li Zhenkai;Zhao Shiwei;Zheng Fanghui;Shen Hailin(Department of Radiology,Suzhou Kowloon Hospital,Shanghai Jiaotong University School of Medicine,Suzhou 215127,China)

机构地区：[1]上海交通大学医学院苏州九龙医院影像科,苏州215127

出　　处：《国际脑血管病杂志》2022年第3期174-178,共5页International Journal of Cerebrovascular Diseases

基　　金：2021年苏州九龙医院科研预研基金项目(SZJL202112)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)对多发性急性脑梗死(acute multifocal cerebral infarction,AMCI)患者Trousseau综合征(Trousseau syndrome,TS)的预测价值。方法回顾性纳入2013年7月至2022年3月期间在上海交通大学医学院苏州九龙医院经临床诊断为AMCI的病例。对TS-AMCI患者和非TS-AMCI患者的人口统计学和基线临床资料进行比较。应用多变量logistic回归分析确定TS-AMCI的独立影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价NLR对TS-AMCI的预测价值。结果研究期间共纳入59例AMCI患者,其中男性43例,女性16例,年龄(64.9±14.0)岁。TS-AMCI组16例,非TS-AMCI组43例。TS-AMCI组糖尿病、高血压以及既往卒中或短暂性脑缺血发作史患者构成比均显著低于非TS-AMCI组(P均<0.05),而缺血性心脏病患者构成比显著高于非TS-AMCI组(P<0.05)。TS-AMCI组双侧梗死的患者比例显著高于非TS-AMCI组(P<0.001)。TS-AMCI组D-二聚体、NLR、白细胞计数、中性粒细胞计数、单核细胞计数、中性粒细胞百分比以及总胆固醇和低密度脂蛋白胆固醇均显著高于非TS-AMCI组(P均<0.001),而淋巴细胞计数、淋巴细胞百分比、红细胞计数、血红蛋白和红细胞比容均显著低于非TS-AMCI组(P均<0.001)。多变量logistic回归分析显示,高NLR是TS-AMCI的独立预测因素[优势比(odds ratio,OR)2.897,95%置信区间(confidence interval,CI)1.270~6.527;P=0.011],而高血红蛋白与TS-AMCI呈独立负相关(OR 0.839,95%CI 0.723~0.975;P=0.022)。ROC曲线分析显示,NLR预测TS-AMCI的曲线下面积为0.929(95%CI 0.831~0.979;P<0.001),当NLR截断值为4.01时,对应的约登指数为0.744,此时的敏感性和特异性分别为100%和74.42%。结论NLR对TS-AMCI具有较高的预测价值。Objective To investigate the predictive value of neutrophil-lymphocyte ratio(NLR)for Trousseau’s syndrome(TS)in patients with acute multiple cerebral infarctions(AMCI).Methods The patients with AMCI in Suzhou Kowloon Hospital,Shanghai Jiaotong University School of Medicine from July 2013 to March 2022 were retrospectively enrolled.The demographic and baseline clinical data of patients with TS and those without TS were compared.Multivariate logistic regression analysis was used to determine the independent influencing factors of TS-AMCI,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of NLR for TS-AMCI.Results A total of 59 patients with AMCI were enrolled,including 43 males and 16 females,aged 64.9±14.0 years.There were 16 patients in the TS-AMCI group and 43 in the non-TS-AMCI group.The proportions of patients with diabetes mellitus,hypertension and previous stroke or transient ischemic attack in the TS-AMCI group were significantly lower than those in the non-TS-AMCI group(all P<0.05),while the proportion of patients with ischemic heart disease were significantly higher than that in the non-TS-AMCI group(P<0.05).The proportion of patients with bilateral infarction in the TS-AMCI group was significantly higher than that in the non-TS-AMCI group(P<0.001).The D-dimer,NLR,white blood cell count,neutrophil count,monocyte count,percentage of neutrophils,total cholesterol and low-density lipoprotein cholesterol in the TS-AMCI group were significantly higher than those in the non-TS-AMCI group(all P<0.001),while the lymphocyte count,lymphocyte percentage,red blood cell count,hemoglobin and hematocrit were significantly lower than those in the non-TS-AMCI group(all P<0.001).Multivariate logistic regression analysis showed that high NLR was an independent predictor of TS-AMCI(odds ratio[OR]2.897,95%confidence interval[CI]1.270-6.527;P=0.011),while high hemoglobin was independently negatively correlated with TS-AMCI(OR 0.839,95%CI 0.723-0.975;P=0.022).ROC curve analysis showed

关 键 词：大脑梗死 肿瘤 中性粒细胞 淋巴细胞 血栓形成 栓塞 弥散磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]