术后血小板-中性粒细胞比值对血管内治疗急性前循环心源性大血管闭塞性卒中的预测价值  

The clinical value of postoperative platelet-to-neutrophil ratio in predicting the outcome of acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment

作　　者：左鹏 倪小宇[1] 吴嶛 倪贵华[1] ZUO Peng;NI Xiaoyu;WU Liao;NI Guihua(Department of Neurology,Affiliated Huai'an No.l People's Hospital of Nanjing Medical University,Huai'an,Jiangsu Province 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院神经内科,江苏淮安223300

出　　处：《介入放射学杂志》2024年第11期1175-1180,共6页Journal of Interventional Radiology

摘　　要：目的探讨术后血小板-中性粒细胞比值(PNR)对急性前循环心源性大血管闭塞性卒中患者血管内治疗的预测价值。方法纳入2019年1月至2022年1月就诊于南京医科大学附属淮安第一医院行血管内治疗的急性心源性大血管闭塞性脑卒中患者95例。采集患者入院时和取栓术后24 h内静脉血,计算PNR、血小板-白细胞比值(PWR)、血小板-淋巴细胞比值(PLR)和中性粒细胞-淋巴细胞比值(NLR)。根据改良Rankin量表90 d评分(mRS-90)将患者分为预后良好组(mRS-90≤2分)45例,预后不良组(mRS-903~6分)50例。比较两组患者的临床资料。多因素logistic回归分析取栓患者90 d良好预后的预测因素。采用受试者工作特征曲线下面积(AUC)比较PWR、PNR和NLR预测取栓患者良好预后的效能。结果与预后不良组相比,预后良好组的年龄和入院时NIHSS评分更低,较少合并术后对比剂外渗,术后24 h的PWR和PNR更高,NLR更低,且差异有统计学意义(P<0.05)。多因素分析表明,桥接治疗(OR=4.746,P=0.021,95%CI:1.262~17.856)、术后对比剂外渗(OR=0.254,P=0.022,95%CI:0.079~0.824)和术后24 h PNR(OR=1.087,P=0.006,95%CI:1.025~1.153)是急性前循环心源性大血管闭塞性卒中患者血管内治疗90 d良好预后的独立预测因素。术后24 h的PWR、PNR和NLR预测取栓术后良好预后的曲线下面积分别为0.734、0.736和0.704。PNR的预测效能最高,截断值为25.08,特异度为84.00%,灵敏度为67.78%。结论急性前循环心源性大血管闭塞性卒中血管内治疗术后24 h PNR较高的患者临床预后可能更好。Objective To investigate the clinical value of postoperative platelet-to-neutrophil ratio(PNR)in predicting the prognosis of patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.Methods A total of 95 patients with acute anterior circulation cardiogenic large-vessel occlusion stroke,who were admitted to the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University of China from January 2019 to January 2022,were enrolled in this study.Venous blood sampling was performed at admission and within 24 hours after thrombectomy,and the PNR,platelet-white blood cell ratio(PWR),platelet-lymphocyte ratio(PLR),and neutrophil-lymphocyte ratio(NLR)were calculated.According to the modified Rankin Scale score at 90 days(mRS-90),the patients were divided into good prognosis group(mRS-90≤2 points,n=45)and poor prognosis group(mRS-903-6 points,n=50).The clinical data were compared between the two groups.Multivariate logistic regression analysis was used to analyze the predictors of 90-d good prognosis.The area under the receiver operating characteristic curve(AUC)was used to compare the efficacy of PWR,PNR,and NLR in predicting good prognosis.Results Compared with poor prognosis group,in good prognosis group the patients were younger,the NIHSS score at admission was smaller,the incidence of postoperative contrast extravasation was lower,the postoperative 24-hour PWR and PNR values were higher,and the postoperative 24-hour NLR value was lower,the differences in the above indexes between the two groups were statistically significant(all P<0.05).Multivariate analysis showed that bridging therapy(OR=4.746,P=0.021,95%CI:1.262-17.856),postoperative contrast medium extravasation(OR=0.254,P=0.022,95%CI:0.079-0.824)and postoperative 24-h PNR(OR=1.087,P=0.006,95%CI:1.025-1.153)were the independent predictors for 90-d good prognosis in patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.

关 键 词：前循环大血管闭塞 心源性卒中 血管内治疗 血小板-中性粒细胞比值 

分 类 号：R543[医药卫生—心血管疾病]