中性粒细胞与淋巴细胞比值对ACI溶栓后出血转化的预测价值  

Predictive value of neutrophil to lymphocyte ratio for bleeding transformation after ACI thrombolysis

作　　者：卢涛声[1] 王国军[1] 朱银伟 戴丹 张亚琴[1] LU Taosheng;WANG Guojun;ZHU Yinwei;DAI Dan;ZHANG Yaqin(Department of Neurology,Changshu First People's Hospital,Changshu Jiangsu 215500,China)

机构地区：[1]常熟市第一人民医院神经内科,江苏常熟215500

出　　处：《中国急救复苏与灾害医学杂志》2023年第6期763-766,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省自然科学基金青年基金项目(编号:BK20170447)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)对急性脑梗死(ACI)溶栓后出血转化的预测价值。方法选择2018年1月—2021年12月常熟市第一人民医院神经内科收治的230例ACI患者为研究对象,所有患者均接受静脉溶栓治疗。溶栓前检测患者NLR水平。统计ACI患者溶栓后48 h出血转化情况,根据患者溶栓后48 h是否出血转化分为转化组与非转化组,收集两组的一般资料,比较转化组与非转化组的临床资料,以Logistic多因素回归法分析影响因素,绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)分析预测价值。对比两组死亡率。结果230例ACI患者中,溶栓后48 h出血转化34例,出血转化率为14.78%,剩余196例未发生出血转化。转化组年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、溶栓前C-反应蛋白(CRP)、降钙素原(PCT)、血糖、NLR水平高于非转化组(P<0.05)。Logistic多因素回归分析结果显示,年龄、溶栓前血糖、NLR水平为ACI患者溶栓后48 h出血转化的影响因素(P<0.05)。ROC曲线结果显示,溶栓前NLR水平预测ACI患者溶栓后48 h出血转化的AUC值为0.713(95%CI:0.599~0.811)(P<0.05)。转化组死亡率高于未转化组(P<0.05)。结论溶栓前NLR水平可用于预测ACI患者溶栓后48 h出血转化。Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)in predicting hemorrhage transformation after thrombolysis in acute cerebral infarction(ACI).Methods A total of 230 patients with ACI admitted to the Department of Neurology of Changshu First People's Hospital from January 2018 to December 2021 were selected as subjects.All patients received intravenous thrombolysis.NLR levels were measured before thrombolysis.The bleeding transformation of ACI patients 48 h after thrombolysis was analyzed and the patients were divided into a transformation group and a non-transformation group according to whether the patients had bleeding transformation 48 h after thrombolysis.General information was collected for both groups.The clinical data of the transformed group and the non-transformed group were compared.The influencing factors were analyzed by Logistic multi-factor regression.The receiver operating characteristics(ROC)curve was plotted,and the predictive value was analyzed by area under the curve(AUC).The mortality rate of the two groups was compared.Results Among 230 patients with ACI,34 had hemorrhage conversion 48 h after thrombolysis,and the bleeding conversion rate was 14.78%,and the remaining 196 had no hemorrhage conversion.Age,national institutes of health stroke scale(NIHSS)score at admission,reactive protein before thrombolysis,the CRP,procalcitonin(PCT),blood glucose and NLR levels of transformation group were higher than those that non-transformation group(P<0.05).Logistic regression analysis showed that age,blood glucose before thrombolysis and NLR level were the factors influencing bleeding transformation at 48 h after thrombolysis in ACI patients(P<0.05).ROC curve results showed that NLR level before thrombolysis predicted the AUC value of bleeding transformation 48 h after thrombolysis in ACI patients was 0.713(95%CI 0.599~0.811)(P<0.05).The mortality in the transformed group was higher than that the non-transformed group(P<0.05).Conclusion NLR level before thrombolysis can be used t

关 键 词：中性粒细胞与淋巴细胞比值 急性脑梗死 溶栓 出血转化 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]