WORSEN评分联合中性粒细胞与淋巴细胞比值对进展性卒中的预测价值  

Predictive value of WORSEN score combined with neutrophil to lymphocyte ratio for progressive stroke

作　　者：杜诚 孔德莲 韦存胜 俞晓蓉 陈校文 DU Cheng;KONG Delian;WEI Cunsheng;YU Xiaorong;CHEN Xiaowen(The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属江宁医院,江苏南京210000

出　　处：《中国实用神经疾病杂志》2025年第3期294-299,共6页Chinese Journal of Practical Nervous Diseases

基　　金：2023年度开放课题研究项目(编号:JSHD202307)。

摘　　要：目的探讨WORSEN评分联合中性粒细胞与淋巴细胞比值(NLR)对进展性卒中的预测价值及意义。方法回顾性分析2021-09—2022-12发病24 h内就诊南京市江宁医院神经内科未接受早期再灌注治疗的300例脑梗死患者资料,按住院期间是否发生早期神经功能恶化分为非进展组和进展组,对2组资料单因素分析,采用二元多因素Logistic回归分析法探索药物治疗的进展性卒中的影响因素,应用受试者工作特征(ROC)曲线分析WORSEN评分[包括控制差的高血糖、既往心肌梗死、影像学结果、梗死面积、高低密度脂蛋白胆固醇和神经学发现]联合NLR对进展性卒中的预测价值。结果300例脑梗死患者中出现进展82例,非进展组218例。进展组初始单一抗血小板治疗的比例、NLR、血糖、纤维蛋白原降解产物(fFDP)、游离三碘甲状腺原氨酸(FT3)、入院NIHSS评分、WORSEN评分、颈内动脉闭塞、大脑中动脉M1段闭塞、纹状体梗死及梗死灶直径15~30 mm占比均高于非进展组,进展组高血压占比、入院24 h内血压变异性、尿素氮、肌酐均低于非进展组,差异均有统计学意义(P<0.05),余因素组间差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,NLR(OR=1.08,95%CI:1.03~1.13)、大脑中动脉M1段闭塞(OR=1.57,95%CI:1.12~2.19)、纹状体梗死(OR=2.16,95%CI:1.30~3.60)、梗死灶直径为15~30 mm(OR=1.81,95%CI:1.08~3.03)是进展性卒中的独立危险因素。ROC曲线分析显示,WORSEN评分联合NLR的截断值为1.50时,预测进展性卒中的敏感度为88.3%,特异度为43.4%,ROC曲线下面积为0.71(95%CI:0.66~0.77,P<0.05)。结论WORSEN评分及NLR高的急性脑梗死患者应引起高度重视。WORSEN评分联合NLR可能成为检测进展性卒中的一个有价值的工具。Objective To investigate the predictive value and significance of WORSEN score combined with neutrophil to lymphocyte ratio in progressive stroke patients.Methods The data of 300 cerebral infarction patients who received non-early reperfusion treatment in Department of Neurology,Nanjing Jiangning Hospital within 24 hours of onset from September 2021 to December 2022 were retrospectively studied.The patients were divided into non-progressive stroke group and progressive stroke group according to whether early neurological function deterioration occurred during hospitalization.Univariate analysis was performed on the data of the two groups.Multivariate Logistic regression analysis was used to explore the risk factors for progressive stroke treated with medical management.Receiver operating characteristics(ROC)curves were used to analyze WORSEN score combined with NLR in the prediction of progressive stroke.The WORSEN score consists of wrong(poor)blood sugar control(W),old myocardial infarction(O),radiological findings(R),infarct size(S),elevated low-density lipoprotein cholesterol(E)and neurological findings(N).Results Among 300 patients with cerebral infarction,82 cases showed progressive stroke and 218 cases were non-progressive stroke.The proportion of initial single antiplatelet use,NLR,blood glucose,fibrinogen degradation product(FDP),free triiodothyronine(FT3),NIHSS score at admission,WORSEN score,internal carotid artery occlusion,M1 segment occlusion of middle cerebral artery and proportion of striatum infarction in the progressive stroke group were all higher than those in the non-progressive stroke group.The proportion of hypertension,blood pressure variability within 24 hours of admission,blood urine nitrogen and creatinine were lower than those in the non-progressive group.All the differences were statistically significant(P<0.05),while there were no statistically significant differences among the remaining factors(P>0.05).Multivariate Logistic regression analysis showed that NLR(OR=1.08,95%CI:1.03-1.13)

关 键 词：进展性卒中 WORSEN评分 中性粒细胞/淋巴细胞比值 早期神经功能恶化 危险因素 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]