外周血白细胞计数及分类比值与急性非心源性缺血性脑卒中患者预后的相关性

Correlation between peripheral blood leukocyte count and classification ratio and prognosis of patients with acute non-cardiogenic ischemic stroke

目的:本研究旨在探讨外周血白细胞计数、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)和淋巴细胞与单核细胞比值(lymphocyte-to-monocyte ratio,LMR)对急性非心源性缺血性脑卒中患者预后的预测价值。方法:研究对象为2017年6月1日—2018年6月1日在承德医学院附属医院神经内科住院的、符合病例选择标准的323例急性非心源性缺血性脑卒中患者,收集人口统计学、血管相关危险因素、相关药物使用史、血常规等实验室检测指标、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、出院时改良Rankin量表(modified Rankin Scale,MRS)评分以及住院时间等资料进行回顾性分析。按照外周血白细胞计数进行分组:≤10.0×109/L、(10.1~11.0)×109/L、(11.1~12.0)×109/L、≥12.1×109/L;按照NLR进行分组:<3.6、3.6~6.5、>6.5;按照LMR进行分组:<2.97、2.97~4.83、>4.83。多因素logistic回归分析急性非心源性缺血性脑卒中患者预后的独立危险因素。受试者操作特征(receiver operator characteristic,ROC)曲线评价外周血白细胞计数、NLR和LMR对预后的预测能力,计算敏感度和特异度。结果:按照MRS评分进行分组:预后良好组(213例,MRS评分≤2)和预后不良组(110例,MRS评分为3~6)。预后不良组的外周血中性粒细胞计数、NLR、超敏C反应蛋白水平、同型半胱氨酸水平和基线NHISS评分均显著高于预后良好组(P<0.05),住院时间也显著延长(P<0.05),而外周血淋巴细胞计数和LMR显著低于预后良好组(P<0.05)。多因素logistic回归分析结果显示,外周血白细胞计数[≤10.0×109·L-1 vs(10.1~11.0)×109·L-1:比值比为1.788,95%置信区间为1.119~2.854,P=0.015]、NLR(比值比为1.275,95%置信区间为1.031~1.576,P=0.025)、LMR(<2.97 vs 2.97~4.83:比值比为0.277,95%置信区间为0.072~0.814,P=0.013)、超敏C反应蛋白水平(比值比为2.389,95%置信区间为1.194~4.799,P=0.014)和基线NHISS评分(比值比为12.630,95%置信区间为6.115~27.741,P<0.001)是急性非心源性缺血性脑卒中患者预后的独立危险因素。ROC曲线结果显示,外周血白细胞计数、NLR和LMR均不是急性非心源性缺血性脑卒中患者预后的理想预测指标,而联合检测可能具有更高的预测价值。结论:外周血白细胞计数、NLR、LMR、超敏C反应蛋白水平和基线NIHSS评分是急性非心源性缺血性脑卒中患者预后(MRS评分)的独立危险因素。鉴于外周血白细胞计数、NLR和LMR的检测简便易行且费用低廉,因此适合临床推广应用。今后有待开展更大样本的多中心前瞻性研究以进一步验证。

Objective:The purpose of this study is to investigate the prognostic value of peripheral blood leukocyte count,neutrophil-to-lymphocyte ratio(NLR)and lymphocyte-to-monocyte ratio(LMR)in patients with acute non-cardiogenic ischemic stroke.Methods:From June 1,2017 to June 1,2018,323 patients with acute non-cardiogenic ischemic stroke who were hospitalized in the Department of Neurology,Affiliated Hospital of Chengde Medical College,met the criteria of case selection.The data of demography,vascular risk factors,drug use history,blood routine test,National Institutes of Health Stroke Scale(NIHSS)score at admission,modified Rankin Scale(MRS)score at discharge and duration of hospitalization were collected for retrospective analysis.According to the peripheral blood leukocyte count,the groups were divided as follows:≤10.0×109/L,(10.1-11.0)×109/L,(11.1-12.0)×109/L and≥12.1×109/L;according to NLR,the groups were divided as follows:<3.6,3.6-6.5 and>6.5;according to LMR,the groups were divided as follows:<2.97,2.97-4.83 and>4.83.Multivariate logistic regression was used to analyze the independent risk factors of prognosis in patients with acute non-cardiogenic ischemic stroke.The receiver operator characteristic(ROC)curve was used to evaluate the predictive ability of peripheral blood leukocyte count,NLR and LMR on prognosis,and calculate the sensitivity and specificity.Results:According to MRS score,the patients were divided into two groups:good prognosis group(213 cases,MRS score≤2)and poor prognosis group(110 cases,MRS score is 3-6).The neutrophil count,NLR,hypersensitive C-reactive protein,homocysteine and baseline NHISS score in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05),and the duration of hospitalization was significantly longer(P<0.05),while the lymphocyte count and LMR in the poor prognosis group were significantly lower than those in the good prognosis group(P<0.05).The results of multivariate logistic regression analysis showed that the peripheral blood leukocyte count[≤10.0×109·L-1 vs(10.1~11.0)×109·L-1:odds ratio:1.788(95%confidence interval:1.119-2.854),P=0.015],NLR[odds ratio:1.275(95%confidence interval:1.031-1.576),P=0.025],LMR[<2.97 vs 2.97-4.83:odds ratio:0.277(95%confidence interval:0.072-0.814),P=0.013],the level of hypersensitive C-reactive protein[odds ratio:2.389(95%confidence interval:1.194-4.799),P=0.014],and the baseline NHISS score[odds ratio:12.630(95%confidence interval:6.115-27.741),P<0.001]were independent risk factors for prognosis of patients with acute non-cardiogenic ischemic stroke.The results of ROC curve showed that leukocyte count,NLR and LMR were not ideal predictors for the prognosis of acute non-cardiogenic ischemic stroke,and the combined detection might have a higher predictive value.Conclusion:Peripheral blood leukocyte count,NLR,LMR,high-sensitivity C-reactive protein level and baseline NIHSS score were independent risk factors of prognosis(MRS score)in patients with acute non-cardiogenic ischemic stroke.Due to the convenience and low cost of peripheral blood leukocyte count,NLR and LMR detection,it is suitable for clinical application.It is necessary to carry out multi-center prospective studies with a larger sample to further verify.