中性粒细胞与淋巴细胞比值等多因素预测急性缺血性脑卒中静脉溶栓后出血转化研究  

NLR combined with other factors in predicting hemorrhage transformation in acute ischemic stroke after intravenous thrombolysis

作　　者：陈宏权[1] 李军根[2] Chen Hongquan;Li Jungen(Department of Neurology,Hexian People's Hospital,Ma'anshan 238200,Anhui Province,China)

机构地区：[1]和县人民医院神经内科,马鞍山238200 [2]苏州大学附属第一医院急诊科

出　　处：《中华老年心脑血管病杂志》2024年第10期1192-1196,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 探讨中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)等多因素对急性缺血性脑卒中(acute ischemic stroke,AIS)患者静脉溶栓后出血转化的预测价值。方法 回顾性选取2020年8月至2024年6月于马鞍山市和县人民医院神经内科接受重组组织型纤溶酶原激活剂静脉溶栓的AIS患者260例,根据溶栓后是否发生出血转化,分为出血转化组42例和非出血转化组218例。比较2组临床基线特征,采用多因素logistic回归分析出血转化的危险因素,绘制ROC曲线分析NLR等危险因素对AIS患者静脉溶栓后出血转化的预测价值。结果在260例静脉溶栓AIS患者中,16.2%(42例)发生出血转化。出血转化组入院时心房颤动、TOAST分型-心源性栓塞型、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、白细胞计数、中性粒细胞计数、NLR显著高于非出血转化组,淋巴细胞计数显著低于非出血转化组,差异有统计学意义(P<0.05,P<0.01);多因素logistic回归分析显示,心房颤动(OR=3.361,95%CI:1.015~15.381)、NHISS评分≥15分(OR=7.785,95%CI:1.348~21.312)、TOAST分型-心源性栓塞型(OR=4.104,95%CI:1.156~17.256)、NLR(OR=3.165,95%CI:1.231~5.265)为出血转化的独立危险因素(P<0.05)。ROC曲线分析显示,NLR联合病因分型等多因素联合预测的曲线下面积为0.841(95%CI:0.763~0.967,P<0.01),对模型进行Hosmer-Lemeshow拟合优度检验(P=0.354),最佳临界值为0.701,敏感性为86.3%,特异性为84.3%。结论 NLR联合TOAST病因分型等多因素联合对静脉溶栓后出血转化的发生有一定的预测价值。Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR) and other factors for hemorrhagic transformation(HT) after intravenous thrombolysis in acute ischemic stroke(AIS).Methods A retrospective study was conducted on 260 AIS patients who received intravenous thrombolysis with alteplase in Department of Neurology of Hexian People’s Hospital from August 2020 to June 2024.According to HT occurred or not after thrombolysis,they were divided into HT group(n=42) and non-HT group(n=218).The clinical baseline data were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors of HT,and ROC curve was drawn to analyze the predictive value of NLR and other risk factors for HT in AIS patients after intravenous thrombolysis.Results Among the 260 AIS patients,42 cases(16.2%) had HT.The proportion of atrial fibrillation and cardioembolism type(TOAST subtype CE),white blood cell count,neutrophils count,NLR,and baseline NHISS score were significantly higher,and the lymphocyte count was obviously lower in the HT group than the non-HT group(all P<0.05).Multivariate logistic regression analysis showed that atrial fibrillation(OR=3.361,95%CI:1.015-15.381),NHISS score ≥15(OR=7.785,95%CI:1.348-21.312),TOAST classification CE(OR=4.104,95%CI:1.156-17.256),and NLR(OR=3.165,95%CI:1.231-5.265) were independent risk factors for HT(all P<0.05).ROC curve analysis showed that the AUC value of NLR combined with above other factors was 0.841(95%CI:0.763-0.967,P<0.01).In Hosmer-Lemeshow goodness of fit test on the model(P=0.354),the best critical value was 0.701,the sensitivity was 86.3%,and the specificity was 84.3%.Conclusion NLR combined with TOAST etiological classification and other factors have a certain predictive value for the occurrence of HT after intravenous thrombolysis.

关 键 词：卒中 脑出血 中性白细胞 TOAST系统 

分 类 号：R743.3[医药卫生—神经病学与精神病学]