全身炎症反应指数、全身免疫炎症指数和CT灌注成像参数预测前循环大血管闭塞所致轻型卒中患者的早期神经功能恶化  

Systemic inflammatory response index,systemic immune-inflammatory index,and CT perfusion imaging parameters predict early neurological deterioration in patients with minor stroke due to anterior circulation large vessel occlusion

作　　者：黄虎 刘志伟 于紫涵 宋春杰 李丹 韩远远 Huang Hu;Liu Zhiwei;Yu Zihan;Song Chunjie;Li Dan;Han Yuanyuan(Department of Interventional Radiology,Suqian First People's Hospital,Suqian 223800,China;Department of Neurology,Suqian First People's Hospital,Suqian 223800,China)

机构地区：[1]宿迁市第一人民医院介入放射科,宿迁223800 [2]宿迁市第一人民医院神经内科,宿迁223800

出　　处：《国际脑血管病杂志》2024年第6期407-413,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨全身炎症反应指数(systemic inflammation response index,SIRI)、全身免疫炎症指数(systemic immune-inflammation index,SII)和CT灌注成像(CT perfusion imaging,CTP)参数对前循环大血管闭塞所致轻型卒中患者早期神经功能恶化(early neurological deterioration,END)的预测价值。方法纳入2021年11月至2023年12月在宿迁市第一人民医院住院治疗的前循环大血管闭塞所致轻型卒中患者。轻型卒中定义为基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤5分,END定义为入院24 h内NIHSS评分较基线时增加≥4分。根据血常规检查结果计算SIRI和SII。根据入院CTP获得脑血容量(cerebral blood volume,CBV)指数、梗死核心体积和早期梗死增长率(early infarct growth rate,EIGR)。采用多变量logistic回归分析确定END的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评价各预测因素对END的预测价值。结果共纳入132例患者,男性85例(64.4%),中位年龄68岁(四分位数间距:58~77岁),39例(29.5%)发生END。END组基线NIHSS评分、空腹血糖、中性粒细胞计数、淋巴细胞计数、SIRI、SII、梗死核心体积和EIGR显著高于非END组,而CBV指数显著低于非END组(P均<0.05)。多变量logistic回归分析显示,SIRI[优势比(odds ratio,OR)3.672,95%置信区间(confidence interval,CI)1.838~6.326;P<0.001]、SII(OR 4.824,95%CI 2.057~7.135;P<0.001)、CBV指数(OR 0.968,95%CI 0.947~0.986;P<0.001)和EIGR(OR 2.527,95%CI 1.918~3.589;P<0.001)是END的独立预测因素。ROC曲线分析显示,SIRI、SII、CBV指数和EIGR预测END的曲线下面积分别为0.780(95%CI 0.692~0.863)、0.798(95%CI 0.709~0.888)、0.775(95%CI 0.697~0.853)和0.772(95%CI 0.732~0.829)。结论SIRI、SII、CBV指数和EIGR是前循环大血管闭塞所致轻型卒中患者END的独立预测因素,对END具有一定的预测价值。Objective To investigate the predictive value of systemic inflammatory response index(SIRI),systemic immune-inflammation index(SII),and CT perfusion imaging(CTP)parameters for early neurological deterioration(END)in patients with mild stroke duo to anterior circulation large vessel occlusion.Methods Patients with minor stroke duo to anterior circulation large vessel occlusion admitted to the First People's Hospital of Suqian from November 2021 to December 2023 were included.Minor stroke was defined as a baseline National Institutes of Health Stroke Scale(NIHSS)score≤5,and END was defined as an increase of≥4 in NIHSS score within 24 hours of admission compared to the baseline.SIRI and SII were calculated based on the findings of blood routine examination.According to CTP at admission,the cerebral blood volume(CBV)index,infarct core volume,and early infarct growth rate(EIGR)were obtained.Multivariate logistic regression analysis was used to determine the independent risk factors for END.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each predictor on END.Results A total of 132 patients were included,with 85 males(64.4%)and a median age of 68 years(interquartile range,58-77 years).Thirty-nine patients(29.5%)experienced END.The baseline NIHSS score,fasting blood glucose,neutrophil count,lymphocyte count,SIRI,SII,infarct core volume,and EIGR in the END group were significantly higher than those in the non-END group,while the CBV index was significantly lower than that in the non-END group(all P<0.05).Multivariate logistic regression analysis showed that SIRI(odds ratio[OR]3.672,95%confidence interval[CI]1.838-6.326;P<0.001),SII(OR 4.824,95%CI 2.057-7.135;P<0.001),CBV index(OR 0.968,95%CI 0.947-0.986;P<0.001),and EIGR(OR 2.527,95%CI 1.918-3.589;P<0.001)were the independent predictive factors of END.ROC curve analysis showed that the area under the curves of SIRI,SII,CBV index,and EIGR for predicting END were 0.780(95%CI 0.692-0.863),0.798(95%CI 0.709-0.888),0.775(95%CI 0.69

关 键 词：缺血性卒中 动脉闭塞性疾病 疾病严重程度指数 炎症 灌注成像 体层摄影术 X线计算机 CT灌注成像 脑血容量 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]