中性粒细胞/淋巴细胞比值预测前循环急性大血管闭塞性缺血性卒中血管内治疗的预后价值  

Prognostic Value of Neutrophil/lymphocyte Ratio in Predicting Endovascular Treatment of Anterior Circulation Acute Large Vessel Occlusive Ischemic Stroke

作　　者：马岚 方珉[2] MA Lan;FANG Min(School of Medicine,Anhui University of Science and Technology,Huainan 232001,Anhui,China;Department of Neurology,Tenth People’s Hospital of Tongji University,Shanghai 200072,China)

机构地区：[1]安徽理工大学医学院,安徽淮南232001 [2]同济大学附属上海第十人民医院神经内科,上海200072

出　　处：《医学信息》2022年第24期102-107,共6页Journal of Medical Information

基　　金：上海市卫生健康委员会项目(编号:202040086)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)与前循环急性大血管闭塞性缺血性卒中(LVO-AIS)患者血管内治疗(EVT)后3个月临床预后的关系。方法选取自2017年1月-2021年10月同济大学附属上海第十人民医院、上海交通大学附属第六人民医院神经内科收治的行EVT的前循环LVO-AIS患者374例,通过门诊或电话方式随访3个月。分别于入院时、血管内治疗后3~7 d采集患者血液,根据术后3个月改良Rankin量表(mRS)评分分为预后良好组(0~2分)、预后不良组(3~6分)。比较两组一般及临床资料,采用二元Logistic回归分析EVT术后3个月预后不良的独立预测因素,应用ROC曲线评估术后3~7 d NLR水平对EVT术后3个月预后不良的预测价值。结果最终纳入患者374例,预后良好组132例(35.29%),预后不良组242例(64.71%)。单因素分析显示,预后不良组入院NLR、术后3~7 d NLR均高于预后良好组(P<0.05);二元Logistic回归分析显示,术后3~7 d NLR升高(OR=1.178,95%CI:1.044~1.329,P=0.008)、7 d美国国立卫生研究院卒中量表(NIHSS)评分是影响预后不良的独立预测因素;ROC曲线显示,术后3~7 d NLR预测前循环LVO-AIS患者EVT术后预后不良的曲线下面积(AUC)为0.783(95%CI:0.737~0.823,P<0.0001),最佳临界值为4.55,敏感度为79.75%,特异度为67.42%;Spearman相关性分析显示,EVT术后3~7 d NLR水平升高与7 d NIHSS评分呈正相关(r=0.463)。结论3~7 d NLR是前循环LVO-AIS患者行血管内治疗后3个月预后不良的独立预测因素,在3~7 d NLR的基础上联合7 d NIHSS评分可提高其预测价值。Objective To investigate the relationship between neutrophil/lymphocyte ratio(NLR)and the clinical prognosis of patients with anterior circulation acute ischemic stroke with large vesselocclusion(LVO-AIS)at 3 months after endovascular treatment(EVT).Methods From January 2017to October 2021,374 patients with anterior circulation LVO-AIS who underwent EVT in the Department of Neurology,Tenth People’s Hospital of Tongji University and Shanghai Sixth People’s hospital Affiliated to Shanghai Jiao Tong University were selected and followed up for 3 months by outpatient or telephone.Blood samples were collected at admission and 3-7 days after endovascular treatment.According to the modified Rankin scale(mRS)score at 3 months after operation,the patients were divided into good prognosis group(0-2 scores)and poor prognosis group(3-6 scores).The general and clinical data of the two groups were compared.Binary logistic regression was used to analyze the independent predictors of poor prognosis3 months after EVT.ROC curve was used to evaluate the predictive value of NLR level 3-7 days after EVT for poor prognosis 3 months after EVT.Results Finally,374 patients were included,132 patients(35.29%)in the good prognosis group and 242 patients(64.71%)in the poor prognosis group.Univariate analysis showed that the NLR at admission and 3-7 d after operation in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Binary Logistic regression analysis showed that increased NLR at 3-7 days after operation(OR=1.178,95%CI:1.044-1.329,P=0.008)and National Institutes of Health Stroke Scale(NIHSS)score at 7 days after operation were independent predictors of poor prognosis.ROC curve showed that the area under the curve(AUC)of NLR at 3-7 days after operation for predicting poor prognosis after EVT in patients with anterior circulation LVO-AIS was 0.783(95%CI:0.737-0.823,P<0.0001),the optimal critical value was 4.55,the sensitivity was 79.75%,and the specificity was 67.42%.Spearman correlation analysis showed

关 键 词：前循环 急性大血管闭塞性缺血性卒中 中性粒细胞与淋巴细胞比值 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]