血清NLR联合AGI分级对急性缺血性卒中患者血管内治疗临床结局的预测价值  

Establishment of a serum NLR combined with AGI grading model to predict clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment

作　　者：范文定 吴曦 苏懿[2] 吴清玉 吴智鑫[2] 魏思源 丘富程 凌皓 李灵知 梁泳彤 FAN Wen-ding;WU Xi;SU Yi;WU Qing-yu;WU Zhi-xin;WEI Si-yuan;QIU Fu-cheng;LING Hao;LI Ling-zhi;LIANG Yong-tong(The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine,Foshan 528000,Guangdong,China;不详)

机构地区：[1]广州中医药大学第八临床医学院,广东佛山528000 [2]佛山市中医院神经重症监护病房(NICU),广东佛山528000

出　　处：《广东医学》2024年第5期583-589,共7页Guangdong Medical Journal

基　　金：国家自然科学基金项目(82374216);广东省中医药局科研项目(20241307);广东省医学科研基金项目(A2023198);佛山市自筹经费类科技创新项目(2220001005576);佛山市卫生健康局医学科研课题(20240720A010143)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)联合急性胃肠损伤分级(AGI)对急性缺血性卒中患者(AIS)血管内治疗(EVT)临床结局的预测价值。方法回顾性纳入卒中中心就诊并接受EVT治疗的AIS患者。根据手术后90 d改良Rankin量表(mRS)分数将患者分为预后良好(mRS≤2分)组和预后不良组(mRS>2分)。收集两组患者临床资料及中医证型。计算术前NLR并记录入院后1周内AGI最高值进行统计分析。研究AIS患者接受EVT后预后不良的风险因素,并利用logistic回归进行分析。同时绘制受试者工作特征(ROC)曲线,评估NLR联合AGI分级对AIS患者接受EVT的预后价值。结果共纳入164例患者,其中预后良好组89例(54.3%),预后不良组75例(45.7%)。预后不良组年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、住院总费用、高血压病比例、三酰甘油、尿素、NLR水平、发生肺炎比例、AGI分级高于预后良好组,淋巴细胞计数水平低于预后良好组(均P<0.05)。预后不良组患者中风痰阻络证比例高于存活组(P<0.05)。多因素logistic回归分析显示,NLR(OR=1.121,95%CI:1.025~1.227,P=0.012)、AGI严重程度(OR=1.936,95%CI:1.233~3.040,P=0.004)、尿素水平(OR=1.343,95%CI:1.036~1.741,P=0.026)、风痰阻络证(OR=3.335,95%CI:1.136~9.568,P=0.025)、发生肺炎(OR=4.529,95%CI:1.444~14.210,P=0.010)为AIS患者行EVT后结局不良的独立危险因素。ROC曲线分析显示,NLR联合AGI分级评估急性缺血性卒中患者血管内治疗预后不良的曲线下面积大于NLR、AGI分级单独评估。结论NLR、AGI对AIS患者EVT治疗的预后评估有一定的预测作用,二者联合可以提高其预测价值。Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR)combined with Acute Gastrointestinal Injury(AGI)grading for the clinical outcomes of patients with acute ischemic stroke(AIS)undergoing endovascular treatment(EVT).Methods A retrospective analysis was conducted on AIS patients treated with EVT at a stroke center.Patients were categorized into good prognosis group(mRS≤2)and poor prognosis group(mRS>2)based on Modified Rankin Scale(mRS)scores 90 days post-surgery.Clinical data and TCM syndrome differentiation were collected for both groups.Preoperative NLR was calculated,and the highest AGI grade within 1 week of admission was recorded for statistical analysis.Risk factors for poor prognosis after EVT in AIS patients were studied,and logistic regression was employed for analysis.Receiver operating characteristic(ROC)curves were also plotted to evaluate the predictive value of NLR combined with AGI grading for the prognosis of AIS patients undergoing EVT.Results A total of 164 patients were included,with 89(54.3%)in the good prognosis group and 75(45.7%)in the poor prognosis group.Patients in the poor prognosis group had higher age,NIH Stroke Scale(NIHSS)scores at admission,total hospitalization costs,prevalence of hypertension,triglyceride levels,urea levels,NLR levels,incidence of pneumonia,and AGI grade compared to those in the good prognosis group(all P<0.05).The proportion of stroke phlegm obstruction syndrome was higher in the poor prognosis group than in the survival group(P<0.05).Multivariable logistic regression analysis showed that NLR(OR=1.121,95%CI:1.025-1.227,P=0.012),severity of AGI(OR=1.936,95%CI:1.233-3.040,P=0.004),urea levels(OR=1.343,95%CI:1.036-1.741,P=0.026),stroke phlegm obstruction syndrome(OR=3.335,95%CI:1.136-9.568,P=0.025),and occurrence of pneumonia(OR=4.529,95%CI:1.444-14.210,P=0.010)were independent risk factors for poor outcomes after EVT in AIS patients.ROC curve analysis showed that the area under the curve for the combined evaluation of NLR and AGI

关 键 词：急性缺血性卒中 血管内治疗 中性粒细胞/淋巴细胞比值 急性胃肠损伤分级 预后 

分 类 号：R741[医药卫生—神经病学与精神病学] R278[医药卫生—临床医学] R446