中性粒细胞/淋巴细胞比值预测接受静脉溶栓治疗的老年急性缺血性卒中患者的出院转归  

Neutrophil/lymphocyte ratio predicts discharge outcome in elderly patients with acute ischemic stroke receiving intravenous thrombolytic therapy

作　　者：朱亚芳 尤寿江[1] 张霞[1] 秦艳[1] 田凤美[2] 谭丽萍[2] 曹勇军[1] 陈冬勤[1] Zhu Yafang;You Shoujiang;Zhang Xia;Qin Yan;Tian Fengmei;Tan Liping;Cao Yongjun;Chen Dongqin(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Nursing Department,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院神经内科,苏州215004 [2]苏州大学附属第二医院护理部,苏州215004

出　　处：《国际脑血管病杂志》2023年第12期889-894,共6页International Journal of Cerebrovascular Diseases

基　　金：2022年度苏州市护理学会科研项目(SZHL-A-202210);苏州大学附属第二医院青年职工预研基金项目-护理专项(SDFEYQN1924)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对接受静脉溶栓(intravenous thrombolysis,IVT)的老年急性缺血性卒中(acute ischemic stroke,AIS)患者出院时转归的预测价值。方法回顾性纳入2018年8月至2020年8月在苏州大学附属第二医院神经内科接受IVT的老年AIS患者。应用改良Rankin量表评估出院时转归,>2分定义为转归不良;有症状颅内出血(symptomatic intracranial hemorrhage,sICH)定义为影像学检查发现的任何颅内出血且伴有神经功能恶化,即美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥4分或出血导致患者死亡。采用多变量logistic回归分析确定发生sICH和出院时转归不良的独立危险因素;采用受试者工作特征(receiver operating characteristics,ROC)曲线分析NLR对出院时转归不良及sICH的预测价值。结果共纳入228例接受IVT的老年AIS患者,男性118例(51.8%),年龄(73.64±8.16)岁,基线NIHSS评分(6.23±6.54)分。90例(39.5%)患者出院时转归不良,16例(7.0%)发生sICH。单变量分析显示,转归不良组NLR显著高于转归良好组(P<0.01)。多变量logistic回归分析显示,NLR较高为出院时转归不良(优势比1.245,95%置信区间1.044~1.484;P<0.05)和sICH(优势比1.124,95%置信区间1.010~1.251;P<0.05)的独立危险因素。ROC曲线分析显示,NLR预测出院时转归不良的曲线下面积为0.693(95%置信区间0.620~0.765;P<0.01),最佳截断值为4.345,其对应的敏感性和特异性分别为47.8%和87.7%;NLR预测sICH的曲线下面积为0.651(95%置信区间0.498~0.804;P<0.05),最佳截断值为3.515,其对应的敏感性和特异性分别为68.8%和61.8%。结论NLR较高与接受IVT的老年AIS患者出院时转归不良和发生sICH独立相关,对出院时转归不良和sICH有一定的预测价值。Objective To investigate the predictive value of neutrophil/lymphocyte ratio(NLR)on the discharge outcome in elderly patients with acute ischemic stroke(AIS)receiving intravenous thrombolysis(IVT).Methods Elderly patients with AIS received IVT in the Department of Neurology,the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included.The modified Rankin Scale was used to evaluate discharge outcome,and the score>2 was defined as poor outcome.Symptomatic intracranial hemorrhage(sICH)was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration,where the National Institutes of Health Stroke Scale(NIHSS)score increased by≥4 from baseline or bleeding led to death.Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome.Receiver operating characteristic(ROC)curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome.Results A total of 228 elderly patients with AIS receiving IVT were enrolled,including 118 males(51.8%),aged 73.64±8.16 years,with a baseline NIHSS score of 6.23±6.54.Ninety patients(39.5%)had poor outcome at discharge,and 16(7.0%)developed sICH.Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group(P<0.01).Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome(odds ratio[OR]1.245,95%confidence interval[CI]1.044-1.484;P<0.05)and sICH(OR 1.124,95%CI 1.010-1.251;P<0.05).ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693(95%CI 0.620-0.765;P<0.01).The optimal cutoff value was 4.345.Its corresponding sensitivity and specificity were 47.8%and 87.7%,respectively.The area under the curve of NLR for predicting sICH was 0.651(95%CI 0.498-0.804;P<0.05).The optimal cutoff value was 3.515.Its corresponding sensitivi

关 键 词：缺血性卒中 血栓溶解疗法 中性粒细胞 淋巴细胞 治疗结果 颅内出血 试验预期值 老年人 

分 类 号：R743.3[医药卫生—神经病学与精神病学]