淋巴细胞/单核细胞比值对急性脑梗死患者预后的预测价值研究

Prognostic Value of Lymphocyte/Monocyte Ratio for patients with Acute Cerebral Infarction

目的:探讨淋巴细胞/单核细胞比值(LMR)对急性脑梗死预后的预测价值。方法:回顾性分析急性脑梗死患者242例的临床资料,根据发病90天改良m RS评分分为预后良好组(163例,m RS 0-2分)和预后不良组(79例,m RS 3-6分),比较其入院时一般人口学资料、美国国立卫生研究院卒中量表评分(NIHSS评分)、血常规、血生化、C反应蛋白(CRP)等资料,根据入院时淋巴细胞与单核细胞计数计算出LMR值,采用logistics回归分析评估LMR与急性脑梗死预后的关系。采用受试者工作特征(ROC)曲线评价入院时LMR水平对急性脑梗预后的预测价值。结果:与预后良好组相比,预后不良组年龄、入院时NIHSS评分、伴随房颤、尿素氮、白细胞、CRP较高,而LMR水平较低,组间差异具有统计学意义(P<0.05)。预后不良组LMR水平较预后良好组明显降低(3.48±2.23 vs. 4.39±1.84,P<0.05),入院时NIHSS评分增高与低水平LMR是预后不良的独立危险因素(OR值分别为2.066、0.835,95%可信区间为1.668-2.559、0.759-0.946,P<0.05)。入院时LMR水平ROC曲线下面积为0.762(95%CI 0.692-0.832),Youden法计算出LMR低于2.633(最佳临界值)预示预后不良,敏感性为86.9%,特异性为47%。结论:入院时LMR水平与急性脑梗死预后不良负相关,低水平LMR对预测急性脑梗死患者预后不良具有一定的参考价值。

Objective: To investigate the predictive value of lymphocyte/monocyte ratio(LMR) for the prognosis of patients with acute cerebral infarction. Methods: From January 2017 to December 2017, a total of 242 patients with acute cerebral infarction were enrolled in this study. The baseline demographic and clinical data of all patients were collected. These patients were divided into either a good prognosis group(n=163) or a poor prognosis group(n=79) according to the modified Rankin scale(m RS) at 90-day. The clinical data including demographic data, National Institutes of Health Stroke Scale(NIHSS) score, blood routine test, blood biochemistry and C reactive protein(CRP) were compared between acute cerebral infarction patients with different prognosis. The LMR value was calculated according to lymphocyte count and monocyte count on admission. Logistic regression analysis was used to assess the risk factors of stroke prognosis. The receiver operating characteristic curve(ROC) was used to estimate the predictive value of LMR for prognostic prediction. Results: There was statistically significant differences in the age, NIHSS on admission, atrial fibrillation, urea nitrogen, white blood cell, LMR, and CRP between the good prognosis group and the poor prognosis group(P<0.05). LMR was significantly lower in the poor prognosis group compared with that of the good prognosis group(3.48±2.23 vs. 4.39±1.84, P<0.05). LMR was an independent risk factor for the poor prognosis(OR 0.835, 95% CI 0.759-0.946, P<0.05). Youden index method indicated that an LMR lower than 2.633 predicted a poor outcome of the patient with acute cerebral infarction, with a sensitivity of 86.9% and specificity of 47.0%. Conclusions:Lower LMR on admission was independently associated with 90-day poor outcome of patients with acute cerebral infarction.