全身炎症反应指数预测急性缺血性卒中患者静脉溶栓治疗后转归  

Systemic inflammatory response index predicts outcomes after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：李玲玲[1] 陈志斌[2] 林永娟[1] 曹娟[1] 陈晓琳[1] Li Lingling;Chen Zhibin;Lin Yongjuan;Cao Juan;Chen Xiaolin(Department of Geriatrics,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Neurology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院老年医学科,南京210008 [2]南京大学医学院附属鼓楼医院神经内科,南京210008

出　　处：《国际脑血管病杂志》2022年第5期321-326,共6页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81400965)。

摘　　要：目的探讨全身炎症反应指数(systemic inflammatory response index,SIRI)与急性缺血性卒中患者静脉溶栓后90 d时转归的相关性。方法回顾性纳入2016年1月至2019年12月在南京鼓楼医院接受静脉溶栓治疗的急性缺血性卒中患者。根据入院时中性粒细胞计数、淋巴细胞计数和单核细胞计数计算得出SIRI。在发病后90 d时采用改良Rankin量表评价转归,0~2分定义为转归良好,3~6分定义为转归不良。应用多变量logistic回归分析评估SIRI与转归不良的独立相关性。应用受试者工作特征(receiver operating characteristic,ROC)曲线评价SIRI对转归不良的预测价值。结果纳入303例接受静脉溶栓治疗的急性缺血性卒中患者,男性178例(58.7%),中位年龄69岁(四分位数间距60~78岁),69例(22.8%)转归不良。转归不良组SIRI显著高于转归良好组(1.53±2.45对3.51±4.73;P<0.05)。多变量logistic分析显示,入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[优势比(odds ratio,OR)1.230,95%置信区间(confidence interval,CI)1.151~1.315;P<0.001]和SIRI(OR 1.240,95%CI 1.074~1.432;P=0.003)与90 d时转归不良显著独立相关。ROC曲线分析显示,SIRI和NIHSS评分单独以及联合预测转归不良的曲线下面积分别为0.721(95%CI 0.650~0.792;P<0.001)、0.824(95%CI 0.771~0.878;P<0.001)和0.853(95%CI 0.804~0.902;P<0.001),最佳截断值分别为1.59、8.00和0.23,敏感性和特异性分别为60.9%和73.9%、76.8%和75.6%、75.4%和82.5%。结论入院时高SIRI与急性缺血性卒中患者静脉溶栓后转归不良独立相关,SIRI可作为静脉溶栓患者转归的预测指标。Objective To investigate the correlation between systemic inflammatory response index(SIRI)and the outcomes at 90 d after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke received intravenous thrombolysis in Nanjing Drum Tower Hospital from January 2016 to December 2019 were retrospectively enrolled.SIRI was calculated according to neutrophil count,lymphocyte count,and monocyte count at admission.The modified Rankin Scale score was used to evaluate the outcomes at 90 d after onset.0-2 was defined as good outcome,and 3-6 were defined as poor outcome.Multivariate logistic regression analysis was used to evaluate the independent correlation between SIRI and poor outcomes.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of SIRI for poor outcomes.Results A total of 303 patients with acute ischemic stroke receiving intravenous thrombolysis were enrolled in the study,including 178(58.7%)males.Their median age was 69 years(interquartile range 60-78 years),and 69 patients(22.8%)had poor outcomes.SIRI in the poor outcome group was significantly higher than that in the good outcome group(1.53±2.45 vs.3.51±4.73;P<0.05).Multivariate logistic regression analysis showed that the National Institutes of Health Stroke Scale(NIHSS)score at admission(odds ratio[OR]1.230,95%confidence interval[CI]1.151-1.315;P<0.001)and SIRI(OR 1.240,95%CI 1.074-1.432;P=0.003)were significantly associated with the poor outcomes at 90 d.ROC curve analysis showed that the areas under the curve for SIRI and NIHSS scores alone and in combination to predict poor outcomes were 0.721(95%CI 0.650-0.792;P<0.001),0.824(95%CI 0.771-0.878;P<0.001)and 0.853(95%CI 0.804-0.902;P<0.001),respectively.The best cut-off values were 1.59,8.00,and 0.23,respectively,and the sensitivity and specificity were 60.9%and 73.9%,76.8%and 75.6%,75.4%and 82.5%,respectively.Conclusions High SIRI at admission is independently associated with 90-day poor outcomes in patients with acute

关 键 词：卒中 脑缺血 炎症 血栓溶解疗法 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]