中性粒细胞／淋巴细胞比值预测卒中相关性肺炎

Neutrophii-to-lymphocyte ratio predicts stroke-associated pneumonia

目的 探讨急性卒中患者外周血中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）在卒中相关性肺炎（stoke-associated pneumonia, SAP）预测中的价值。 方法 纳入连续的急性卒中患者，收集其临床资料，在入院24 h内检测外周血白细胞、中性粒细胞和淋巴细胞计数并计算NLR，应用多变量logistic回归分析确定NLR与SAP的独立相关性，并应用受试者工作特征（receiver operating characteristic, ROC）曲线分析NLR对SAP的预测价值。 结果 共纳入126例卒中患者，男性81例（64.3%），女性45例（35.7%）；年龄53～94岁，平均年龄64.8岁；脑出血52例（41.3%），缺血性卒中74例（58.7%）；发生SAP 39例（31.0%），未发生SAP 87例（69.0%）。SAP组年龄、美国国立卫生研究院卒中量表评分、空腹血糖、白细胞计数、中性粒细胞计数、NLR以及高脂血症、缺血性心脏病、心房颤动、吸烟、吞咽困难、使用制酸药和留置胃管患者比例显著高于非SAP组，而高密度脂蛋白胆固醇和淋巴细胞计数显著低于非SAP组（P均〈0.05）。多变量logistic回归分析显示，在校正混杂因素后，NLR（优势比2.079，95%可信区间1.174～3.194；P＝0.001）是患者发生SAP的独立危险因素。ROC曲线分析显示，当NLR截断值为6.765时，预测SAP的敏感性为64.1%，特异性为73.6%，ROC曲线下面积为0.721（95%可信区间0.630～0.813）。 结论 入院24 h内外周血NLR升高对急性卒中患者的SAP具有一定的预测价值。

Objective To investigate the predictive value of peripheral blood neutrophil-to-lymphocyte ratio （NLR） for stroke-associated pneumonia （SAP） in patients with acute stroke. Methods Consecutive patients with acute stroke were enrolled. Their clinical data were collected. The peripheral blood white blood cells, neutrophil and lymphocyte counts were detected within 24 h after admission, and the NLR was calculated. Multivariate logistic regression analysis was used to determine the independent correlation between NLR and SAP. The receiver operating characteristic （ROC） curve was used to analyze the predictive value of NLR for SAP. Results A total of 126 patients with acute stroke were enrolled, including 45 females （35.7%） and 81 males （64.3%）. Their mean age was 64.8 years. Fifty-two patients （41.3%） had intracerebral hemorrhage, and 74 （58.7%） had ischemic stroke. Thirty-nine patients （31.0%） occurred SAP, and 87 （69.0%） did not occur SAP. Univariate analysis showed that age, National Institutes of Health Stroke Scale scores, fasting glucose, total white blood cell count, neutrophil count, NLR, and proportions of patients with hyperlipidemia, ischemic heart disease, atrial fibrillation, smoking, dysphagia, using acid suppressing drugs and indwelling gastric tube in the SAP group were significantly higher than those in the non-SAP group （all P〈0.05）, and the high-density lipoprotein cholesterol level and lymphocyte count in the SAP group were significantly lower than those in the non-SAP group （all P〈0.05）. Multivariate logistic regression analysis showed that NLR （odds ratio 2.079, 95% confidence interval 1.174-3.194; P=0.001） was an independent risk factor for SAP after adjustment for confounding factors. ROC curve analysis showed that when the NLR cutoff value was 6.765, the sensitivity of predicting SAP was 64.1%, the specificity was 73.6%, and the area under ROC curve was 0.721 （95% confidence interval 0.630-0.813）. Conclusions The elevated NLR in peripheral blood within 24 h after admission may has a certain predictive value for SAP in patients with acute stroke.