入院时中性粒细胞／淋巴细胞比值鉴别小卒中患者的大动脉粥样硬化与小血管闭塞

Neutrophii to lymphocyte ratio at admission for identification of large artery atherosclerosis and small vascular occlusion in patients with minor stroke

目的探讨入院时中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio, NLR）对小卒中患者大动脉粥样硬化（large-artery atherosclerosis, LAA）和小血管闭塞（small vessel occlusion, SVO）的鉴别作用。方法回顾性纳入＂南京卒中注册登记系统＂收录的急性首发缺血性卒中患者，小卒中定义为基线美国国立卫生研究院卒中量表评分≤3分。应用二元logistic回归分析评价NLR与LAA的独立相关关系，受试者工作特征（receiver operating characteristic, ROC）曲线评价NLR对LAA的预测价值。结果共纳入417例小卒中患者，其中LAA组242例，SVO组175例。采用单变量分析显示，LAA组与SVO组患者白细胞计数、中性粒细胞计数、淋巴细胞计数、NLR、糖化血红蛋白、高密度脂蛋白胆固醇、发病至就诊时间以及发病至NLR检测时间存在显著差异（P均〈0.05）。二元logistic回归分析提示，对性别和高密度脂蛋白胆固醇进行调整后，NLR[以最高四分位数组设为参照，第1四分位数组：优势比（odds ratio, OR）0.207，95%可信区间（confidence interval, CI）0.089～0.482；P〈0.001；第2四分位数组：OR 0.277，95% CI 0.122～0.625，P＝0.002；第3四分位数组：OR 0.456，95% CI 0.197～1.057；P＝0.067]、发病至NLR检测时间（OR 1.216，95% CI 1.038～1.424；P＝0.015）、糖化血红蛋白（OR 1.414，95% CI 1.142～1.751；P＝0.002）与LAA独立相关。7 d内就诊患者NLR预测LAA分型的ROC曲线下面积为0.611，24 h内就诊患者ROC曲线下面积为0.673。结论NLR增高与小卒中患者的LAA分型独立相关，早期NLR值对LAA分型的预测价值可能更高。

Objective To investigate the differential effect of neutrophil to lymphocyte ratio （NLR） at admission on large artery atherosclerosis （LAA） and small vessel occlusion （SVO） in patients with minor stroke. Methods Patients with first-ever acute ischemic stroke registered in Nanjing Stroke Registration System were enrolled retrospectively. Minor stroke was defraed as the National Institutes of Health Stroke Scale （NIHSS） score ≤3. Binary logistic regression was used to evaluate the independent relationship between NLR and LAA. Resulls A total of 417 patients with minor stroke were included, of which 242 were in a LAA group and 175 were in a SVO group. Univariate analysis showed that there were significant differences in leukocyte count, neutrophil count, lymphocyte count, NLR, glycosylated hemoglobin, high- density lipoprotein cholesterol, onset to treatment time, and onset to NLR detection time between the patients of the LAA group and the SVO group （all P 〈0. 05）. Binary logistic regression analysis suggested that after adjusting for sex and high-density lipoprotein cholesterol, NLR （with the highest quartile as a reference, the first quartile： odds ratio [ OR] 0. 207, 95% confidence interval [ CI]0. 089-0. 482; P 〈 0. 001 ; the second quartile： OR 0. 277, 95% CI 0. 122-0. 625, P =0. 002; the third quartile： OR 0. 456, 95% CI 0. 197-1. 057; P=0. 067）, onset to NLR detection time （OR 1. 216, 95% CI 1. 038-1. 424; P=0. 015）, and glycosylated hemoglobin （OR 1. 414, 95% CI 1. 142-0. 751; P=0. 002） were independently associated with LAA. The area under the ROC curve of NLR predicting the LAA was 0. 611 in patients admitted within 7 d after onset, and was 0. 673 in patients admitted within 24 h after onset. Conclusions The increased NLR was independently associated with the LAA in patients with minor stroke. Early NLR value may have higher predictive value for LAA.