超敏C反应蛋白及中性粒细胞与淋巴细胞比值对缺血性卒中青年患者预后的预测作用

Predictive effect of hypersensitive C-reactive protein and neutrophil and lymphocyte ratio on the prognosis of young patients with ischemic stroke

目的探讨超敏C反应蛋白(Hs-CRP)及中性粒细胞与淋巴细胞比值(NLR)对缺血性卒中青年患者预后的预测作用。方法回顾性连续纳入2016年10月至2017年10月首都医科大学宣武医院诊断为缺血性卒中的青年(18～45岁)患者110例,根据改良Rankin量表(mRS)评分,分为预后良好(mRS≤2分)组90例,预后不良(mRS>2分)组20例。患者入院24 h内完善相关检查,包括血常规和Hs-CRP等,并根据血常规中的中性粒细胞和淋巴细胞计数计算NLR值。记录两组患者年龄、性别、基础疾病(高血压病、糖尿病、高脂血症、高同型半胱氨酸血症)、烟酒史、NIHSS评分等,以患者出院后90 d不良预后作为因变量,将单因素分析中P<0.05的自变量进一步行多因素Logistic回归分析。采用受试者工作特征曲线(ROC)评价独立危险因素的敏感度及特异度,计算Youden指数并确定诊断最佳截断值。结果 (1)与预后良好组比较,预后不良组患者入院时的NIHSS评分、NLR及Hs-CRP均较高,组间差异具有统计学意义[9.0(4.5,13.0)分比2.5(2.0,4.0)分,2.97(2.31,4.20)比2.13(1.76,2.70),4.65(2.70,9.52)mg/L比2.06(0.87,4.54)mg/L;均P<0.05];其余基线资料及临床特征的组间差异无统计学意义(均P>0.05)。(2)多因素Logistic回归分析结果显示,入院时高水平Hs-CRP(OR=1.086,95%CI:1.009～1.169)和NIHSS评分较高(OR=1.487,95%CI:1.229～1.797)是预后不良的独立危险因素(均P<0.05),而NLR与预后无明显关系(P>0.05)。(3)入院Hs-CRP水平ROC曲线下的面积为0.722(95%CI:0.591～0.853,P=0.002),当入院Hs-CRP的水平预测值为3.365 mg/L时,对应的敏感度为70.0%,特异度为66.7%。结论入院时Hs-CRP水平及NIHSS评分较高均可在一定程度上独立预测缺血性卒中青年患者出院90 d预后不良,不宜单独使用Hs-CRP≥3.365 mg/L进行预后不良的筛选,但入院时NLR水平可能与预后无关。

Objective To investigate the predictive effect of hypersensitive C-reactive protein（ HsCRP） and neutrophil and lymphocyte ratio（ NLR） on the prognosis in young patients with ischemic stroke.Methods From October 2016 to October 2017,110 consecutive young patients（ 18-45 years old） with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. According to the modified Rankin scale（ mRS） scores,they were divided into either a good prognosis group（ mRS≤2; n = 90） or a poor prognosis group（ mRS 2; n = 20）. The patients completed the related examinations within 24 h after admission,including blood routine and Hs-CRP. The NLR value was calculated according to the count of neutrophils and lymphocyte in blood routine. The age,gender,underlying diseases（ hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia）,histories of smoking and drinking,National Institutes of Health stroke scale（ NIHSS） scores of both groups of patients were documented. The poor prognosis after discharge at 9 0 d was used as the dependent variable,the independent variables of P 〈 0. 05 in univariate analysis were further performed with multivariate logistic regression analysis. The receiver operating characteristic（ ROC） curve was used to evaluate the sensitivity and specificity of the independent risk factors. The Youden index was calculated and the optimal cut-off value was determined. Results（ 1） Compared with the good prognosis group,the poor prognosis group had higher NIHSS score,NLR and Hs-CRP at admission. The differences between the 2 groups were statistically significant（ 9. 0[4. 5,13. 0] vs. 2. 5 [2. 0,4. 0 ],2. 97 [2. 31,4. 20] vs. 2. 13 [1. 76,2. 70 ],4. 65[2. 70,9. 52]mg/L vs. 2. 06 [0. 87,4. 54]mg/L; all P 〈 0. 05）. There were no significant differences in other baseline data and clinical characteristics between the two groups（ all P 〈 0. 05）.（ 2） The results of the multivariate logistic regression analysis indicated that the high level of Hs-CRP（ OR,1. 086,95% CI1. 009-1. 169） and higher NIHSS score（ OR,1. 487,95% CI 1. 229-1. 797） at admission were the independent risk factors for poor prognosis（ all P 〈 0. 05）,and there was no significant relation between NLR and prognosis（ P 〈 0. 05）.（ 3） The area under the ROC curve of the Hs-CRP levels at admission was 0. 7 2 2（ 95% CI 0. 591-0. 853,P = 0. 002）. When the predictive value of Hs-CRP level at admission was 3. 365 mg/L,the maximum Youden index was 0. 367,its corresponding sensitivity was 70. 0%and specificity was 66. 7%. Conclusions The higher Hs-CRP level and NIHSS score at admission may independently predict the poor prognosis of young patients with ischemic stroke at 90 d after discharge to a certain extent. It is not appropriate to use Hs-CRP ≥3. 365 mg/L alone for poor prognosis screening,but NLR may not be associated with the prognosis at admission.