中性粒细胞/淋巴细胞比值预测颅内静脉窦血栓形成患者抗凝治疗短期预后的价值  

Value of neutrophil to lymphocyte ratio to the prediction of short-term prognosis of patients with intracranial venous sinus thrombosis after anticoagulant therapy

作　　者：陈瑞芳 张东亚 杨硕 赵松耀 李世泽 CHEN Ruifang;ZHANG Dongya;YANG Shuo;ZHAO Songyao;LI Shize(Department of Neurology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州大学附属郑州中心医院神经内科,河南郑州450000

出　　处：《中华实用诊断与治疗杂志》2025年第1期27-31,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(LHGJ20220857)。

摘　　要：目的 分析抗凝治疗的颅内静脉窦血栓形成(CVST)患者短期预后的影响因素,探讨中性粒细胞/淋巴细胞比值(NLR)对其预后的预测价值。方法 2018年5月—2024年5月郑州大学附属郑州中心医院行抗凝治疗的CVST患者58例,根据治疗后90 d改良Rankin量表评分(mRS)分为预后良好组(mRS 0~1分)49例和预后不良组(mRS 2~6分)9例。比较2组性别比例、年龄、既往史、发病至入院时间、D-二聚体、高敏C反应蛋白(hs-CRP)、NLR等临床资料;采用多因素logistic回归分析CVST患者抗凝治疗后短期预后不良的影响因素;绘制ROC曲线,评估治疗前hs-CRP、NLR预测CVST患者抗凝治疗后短期预后不良的价值。结果 (1)预后不良组年龄[45.3(26.0,77.0)岁]大于预后良好组[36.7(21.0,72.0)岁](U=-1.988,P=0.047),抗凝治疗前D-二聚体[2.50(1.49,3.25)mg/L]、hs-CRP[20.00(13.33,32.05)mg/L]、NLR[5.60(4.40,6.41)]均高于预后良好组[1.45(1.08,1.89)mg/L,13.50(7.25,20.25)mg/L,3.45(2.78,4.45)](U=-3.211~-2.158,P均<0.05),性别比例、既往史、发病至入院时间等其他临床资料与预后良好组比较差异均无统计学意义(P均>0.05)。(2)治疗前hs-CRP(OR=1.154,95%CI:1.000~1.330,P=0.049)、NLR(OR=4.084,95%CI:1.530~10.905,P=0.005)是CVST患者抗凝治疗后短期预后不良的影响因素。(3)治疗前hs-CRP、NLR分别以16.15 mg/L、5.35为最佳截断值,预测CVST患者抗凝治疗后短期预后不良的AUC分别为0.728(95%CI:0.554~0.902,P=0.031)、0.839(95%CI:0.654~1.000,P=0.001),灵敏度分别为77.8%、66.7%,特异度分别为61.2%、95.9%;二者联合预测CVST患者抗凝治疗后短期预后不良的AUC为0.893(95%CI:0.718~1.000,P<0.001),灵敏度为93.9%,特异度为88.9%。结论 抗凝治疗前NLR及hs-CRP增高的CVST患者短期预后不良风险增大,治疗前NLR在预测CVST患者抗凝治疗后的短期预后中有较高价值,联合hs-CRP可进一步提高预测效能。Objective To analyze the factors influencing short-term prognosis of patients with cerebral venous sinus thrombosis(CVST) after anticoagulant therapy,and to explore the value of the neutrophil to lymphocyte ratio(NLR) to the prediction of prognosis.Methods From May 2018 to May 2024,58 patients with CVST received anticoagulant therapy in Zhengzhou Central Hospital Affiliated to Zhengzhou University,and were divided into 49 patients with modified Rankin Scale(mRS) 0-1(the good prognosis group) and 9 patients with mRS 2-6(the poor prognosis group) based on the mRS 90 d after therapy.The gender ratio,age,previous disease history,time from onset to admission,D-dimer,high-sensitivity C-reactive protein(hs-CRP),NLR and other clinical data were compared between two groups.Multivariate logistic regression was used to analyze the factors influencing short-term poor prognosis in patients with CVST.ROC curves were drawn to evaluate the values of hs-CRP and NLR before therapy to the prediction of short-term poor prognosis.Results(1)The age was older in the poor prognosis group[45.3(26.0,77.0)years]than that in the good prognosis group[36.7(21.0,72.0)years](U=-1.988,P=0.047),and the D-dimer,hs-CRP and NLR before therapy were higher in the poor prognosis group [2.50(1.49,3.25)mg/L,20.00(13.33,32.05)mg/L,5.60(4.40,6.41)]than those in the good prognosis group [1.45(1.08,1.89)mg/L,13.50(7.25,20.25)mg/L,3.45(2.78,4.45)](U=-3.211to-2.158,all Pvalues<0.05).There were no significant differences in the other clinical data such as gender ratio,previous disease history and time from onset to admission between two groups(all Pvalues>0.05).(2)The hs-CRP before therapy(OR=1.154,95%CI:1.000-1.330,P=0.049)and NLR(OR=4.084,95%CI:1.530-10.905,P=0.005)were the influencing factors of short-term poor prognosis after therapy.(3)With 16.15 mg/L and 5.35as the optimal cut-off values of hs-CRP and NLR before therapy,the AUCs for predicting short-term poor prognosis were 0.728(95%CI:0.554-0.902,P=0.031)and 0.839(95%CI:0.654-1.000,P=0.001),with the sens

关 键 词：颅内静脉窦血栓形成 抗凝治疗 中性粒细胞/淋巴细胞比值 高敏C反应蛋白 短期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]