入院时中性粒细胞/淋巴细胞比值预测静脉溶栓的急性缺血性卒中患者的出血性转化  

Neutrophil to lymphocyte ratio at admission predicts hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：任雅芳 郑世茹 刘冰[1] 王春慧 范文斐 付胜奇 张淑玲[1] Ren Yafang;Zheng Shiru;Liu Bing;Wang Chunhui;Fan Wenfei;Fu Shengqi;Zhang Shuling(Department of Neurology,the Fifth Clinical Medical College,Henan University of Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)神经内一科,450003

出　　处：《国际脑血管病杂志》2023年第6期418-423,共6页International Journal of Cerebrovascular Diseases

基　　金：河南省医学科技攻关计划省部共建项目(SB201903029)。

摘　　要：目的探讨急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓(intravenous thrombolysis,IVT)后出血性转化(hemorrhagic transformation,HT)的危险因素以及中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)对IVT后HT的预测价值。方法回顾性连续纳入2021年1月至2022年12月在郑州人民医院接受IVT治疗的AIS患者。HT定义为入院首次影像学检查未发现颅内出血,IVT后24 h或症状加重时影像学检查显示新发颅内出血。sHT定义为HT且美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较入院时增加≥4分或需要插管、去骨瓣减压等手术治疗。收集患者基线临床及实验室资料,计算NLR、淋巴细胞/单核细胞比值(lymphocyte to monocyte ratio,LMR)以及血小板/中性粒细胞比值(platelet to neutrophil ratio,PNR)。采用多变量logistic回归分析确定HT和sHT的独立预测因素,采用受试者工作特征曲线分析NLR对IVT后HT及sHT的预测价值。结果共纳入196例患者,年龄(65.37±13.10)岁,男性124例(63.3%),中位基线NIHSS评分4分(四分位数间距2~10分)。20例(10.2%)发生HT,12例(6.1%)发生sHT。单变量分析显示,HT组年龄、基线NIHSS评分、肌酐、NLR和卒中病因学分型与非HT组差异有统计学意义(P均<0.05),sHT组年龄、NLR、PNR、肌酐、基线NIHSS评分和卒中病因学分型与非sHT组差异有统计学意义(P均<0.05)。多变量logstic回归分析显示,NLR为静脉溶栓后发生HT[优势比(odds ratio,OR)1.375,95%置信区间(confidence interval,CI)1.132~1.670;P=0.001]和sHT(OR 1.647,95%CI 1.177~2.304;P=0.004)的独立预测因素。受试者工作特征曲线分析显示,NLR预测HT的曲线下面积为0.683(95%CI 0.533~0.833;P=0.007),最佳截断值为5.78,敏感性和特异性分别为55.0%和84.1%;NLR预测sHT的曲线下面积为0.784(95%CI 0.720~0.839;P=0.001),最佳截断值为5.94,敏感性和特异性分别66.67%和84.24%。结论较高的基线NLR与AIS患者IVT后Objective To investigate the risk factors for hemorrhagic transformation(HT)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS),and the predictive value of Neutrophil to lymphocyte ratio(NLR).Methods Consecutive patients with AIS received IVT in Zhengzhou People’s Hospital from January 2021 to December 2022 were retrospectively enrolled.HT was defined as no intracranial hemorrhage was found on the first imaging examination after admission,and new intracranial hemorrhage was found on the imaging examination 24 h after IVT or when symptoms worsened.sHT was defined as HT and the National Institutes of Health Stroke Scale(NIHSS)score increased by≥4 compared to admission or required surgical treatment such as intubation and decompressive craniectomy.The baseline clinical and laboratory data of the patients were collected,and NLR,lymphocyte to monocyte ratio(LMR),and platelet to neutrophil ratio(PNR)were calculated.Multivariate logistic regression analysis was used to identify the independent predictors of HT and sHT,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR for HT and sHT after IVT.Results A total of 196 patients were included(age 65.37±13.10 years,124 males[63.3%]).The median baseline NIHSS score was 4(interquartile range:2-10).Twenty patients(10.2%)developed HT,and 12(6.1%)developed sHT.Univariate analysis showed that there were statistically significant differences in age,baseline NIHSS score,creatinine,NLR,and stroke etiology type between the HT group and the non-HT group(all P<0.05);there were statistically significant differences in age,NLR,PNR,creatinine,baseline NIHSS score,and stroke etiological type between the sHT group and the non-sHT group(all P<0.05).Multivariate logistic regression analysis showed that NLR was an independent predictor of HT(odds ratio[OR]1.375,95%confidence interval[CI]1.132-1.670;P=0.001)and sHT(OR 1.647,95%CI 1.177-2.304;P=0.004)after IVT.The ROC curve analysis showed that the area under the curve fo

关 键 词：缺血性卒中 血栓溶解疗法 颅内出血 中性粒细胞 淋巴细胞 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]