术前外周血炎症指标对颈动脉支架置入术后同侧新发无症状缺血性脑损伤的预测价值  

Prognostic value of preoperative peripheral blood inflammatory makers for carotid artery stenting ipsilateral new silence ischemic brain lesions

作　　者：杨毅 申珅 万孟夏 张拥波[1] Yi Yang;Shen Shen;Mengxia Wan;Yongbo Zhang(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050

出　　处：《中华脑血管病杂志(电子版)》2025年第1期13-18,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：国家自然科学基金资助项目(81671191)。

摘　　要：目的探讨术前外周血炎症指标对颈动脉支架置入术(CAS)后同侧新发无症状缺血性脑损伤(INSIBL)的预测价值。方法回顾性分析2018年10月至2021年2月首都医科大学附属北京友谊医院行CAS的患者89例,根据是否存在INSIBL,分为INSIBL组40例和non-INSIBL组49例,收集患者基线资料、实验室检查及影像学检查指标,计算外周血中性粒细胞与淋巴细胞比值(NLR)和衍生中性粒细胞与淋巴细胞比值(dNLR),NLR和dNLR可反映全身炎症状态,利用独立样本t检验、χ^(2)检验或秩和检验比较INSIBL组和non-INSIBL组上述资料的差异,采用多因素Logistic回归探索CAS术后INSIBL的影响因素,应用受试者操作特征(ROC)曲线评价NLR、dNLR对CAS后INSIBL的预测价值。结果(1)INSIBL组患者入院时收缩压高于non-INSIBL组[(145.1±19.7)mmHg vs(139.2±18.7)mmHg],差异具有统计学意义(t=4.434,P=0.046);(2)INSIBL组淋巴细胞计数低于non-INSIBL组[1.26(0.92,1.37)×10^(9)/L vs 1.63(1.41,1.99)×10^(9)/L],差异具有统计学意义(Z=7.921,P=0.010];INSIBL组NLR及dNLR高于non-INSIBL组[4.80(1.98,7.77)vs 2.38(1.57,3.70);3.50(1.65,5.35)vs 1.62(1.00,2.50)],差异具有统计学意义(Z=13.357、12.885,P均<0.001)。(3)多因素Logistic回归分析结果提示NLR[校正OR=1.774,95%CI:1.487~2.132,P=0.001]、dNLR[校正OR=1.828,95%CI:1.487~2.485,P<0.001]是CAS后INSIBL的独立影响因素;(4)ROC曲线分析提示,NLR预测CAS后INSIBL的曲线下面积(AUC)为0.72[95%CI:0.62~0.83,P<0.001],NLR的截断值为4.52,敏感度为75.0%,特异度为65.3%;dNLR预测CAS后INSIBL的AUC为0.70[95%CI:0.59~0.81,P=0.001],dNLR的截断值为2.87,敏感度为70.0%,特异度为63.3%。结论NLR和dNLR是CAS后INSIBL的独立影响因素,其中NLR对CAS术后INSIBL的预测价值更高。Objective To investigate the value of peripheral blood inflammatory makers in predicting ipsilateral new silent ischemic brain lesions(INSIBL)following carotid artery stenting(CAS).Methods A retrospective study was conducted to analyze the clinical data of 89 patients with CAS in Beijing Friendship Hospital,Capital Medice Universioy from October 2018 to February 2021.The patients were divided into two groups:the INSIBL group(40 cases)and the non-INSIBL group(49 cases).Data collected included general information,laboratory examination results,and imaging findings.Neutrophil to lymphocyte ratio(NLR)and derived neutrophil-to-lymphocyte ratio(dNLR)in peripheral blood were used as indicators of systemic inflammation.The influencing factors of INSIBL in patients with CAS were analyzed.using independent t-tests,χ^(2)test,Rank sum test,multivariate Logistic regression,and receiver operating characteristic(ROC)curve.Results(1)Systolic blood pressure on admission in the INSIBL group were statistically significantly higher than that in the non-INSIBL group[(145.1±19.7)mmHg vs(139.2±18.7)mmHg,t=4.434,P=0.046].(2)Lymphocyte count in the INSIBL group is lower than that in the non-INSIBL group[1.26(0.92,1.37)×10^(9)/L vs 1.63(1.41,1.99)×10^(9)/L,Z=7.921,P=0.010],and both NLR and dNLR were significantly higher in the INSIBL group compared to the non-INSIBL group[NLR:4.80(1.98,7.77)vs 2.38(1.57,3.70),Z=13.357,P<0.001;dNLR:3.50(1.65,5.35)vs 1.62(1.00,2.50),Z=12.885,P<0.001].(3)Multivariate Logistic regression analysis results showed that NLR[adjusted odds ratio(aOR)=1.774,95%confidence interval(CI):1.487-2.132,P=0.001]and dNLR[aOR=1.828,95%CI:1.487-2.485,P<0.001]were independent influencing factors of CAS-INSIBL.(4)ROC curves demonstrated that the optimal cutoff value of NLR was 4.52(sensitivity 75.0%,specificity 65.3%),the area under the curve(AUC)value is 0.72(95%CI:0.62-0.83,P<0.001).For dNLR,the optimal cutoff value was 2.87(sensitivity 70.0%,specificity 63.3%),the AUC value 0.70(95%CI:0.59-0.81,P=0.001).Conclusion NLR an

关 键 词：颈动脉支架置入术 同侧新发无症状缺血性脑损伤 中性粒细胞 淋巴细胞 炎症反应 

分 类 号：R743.3[医药卫生—神经病学与精神病学]