入院时中性粒细胞/淋巴细胞比值对急性缺血性卒中大血管闭塞的预测价值

Predictive value of neutrophil to lymphocyte ratio at admission for large vessel occlusion in acute ischemic stroke

目的 探讨中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）对急性缺血性卒中患者大血管闭塞（large vessel occlusion,LVO）的预测价值.方法 回顾性纳入2016年1月至2017年12月在广州市第一人民医院住院的急性缺血性卒中患者的临床资料.根据入院6 h内血常规结果 计算NLR,应用多变量logistic回归分析确定NLR与LVO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LVO的预测价值.结果共纳入109例急性缺血性卒中患者,平均年龄63.6岁,男性67例（61.5％）,46例（42.2％）存在LVO.LVO组心房颤动、既往卒中或短暂性脑缺血发作史的患者比例以及美国国立卫生研究院卒中量表评分、白细胞计数、NLR、中性粒细胞计数和空腹血糖水平显著高于非LVO组,而淋巴细胞计数显著低于非LVO组（P均〈0.05）.多变量logistic回归分析显示,在校正混杂因素后,NLR是LVO的独立危险因素（优势比2.768,95％ 可信区间2.272～4.984;P=0.001）.NLR预测LVO的ROC曲线分析显示,曲线下面积为0.712（95％ 可信区间0.638～0.793）,最佳截断值为4.18,敏感性和特异性分别为79.3％ 和73.6％.结论 早期外周血NLR高可有效预测急性缺血性卒中LVO.

Objective To investigate the predictive value of neutrophil to lymphocyte ratio （NLR） at admission for large vessel occlusion （LVO） in patients with acute ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to Guangzhou First People＇s Hospital from January 2016 to November 2017 were enrolled retrospectively. NLR was calculated according to results of blood routine examination within 6 h after admission. Multivariate logistic regression analysis was used to determine the independent correlation between NLR and LVO. The receiver operating characteristic （ROC） curve was used to analyze the predictive value of NLR for LVO. Results A total of 109 patients with acute ischemic stroke were enrolled, including 42 females （38. 5%） and 67 males （61. 5%）. Their mean age was 63. 6 years. Forty-six patients （42. 2%） had LVO. The proportions of patients with atrial fibrillation, previous stroke or transient ischemic attack, and the National Institutes of Health Stroke Scale score, white cell count, NLR, neutrophil count, and fasting blood glucose in the LVO group were significantly higher than those in the non- LVO group, while lymphocyte count was significantly lower than that in the non-LVO group （all P 〈 0. 05）. Multivariate logistic regression analysis showed that NLR was an independent risk factor for LVO after adjusting for the confounding factors （odds ratio 2. 768, 95% confidence interval, 2. 272-4. 984; P = 0. 001）. The ROC curve analysis of NLR predicting LVO showed that the area under the curve was 0. 712 （95% confidence interval 0. 638-0. 793）, and the sensitivity and specificity were 79. 3% and 73. 6% respectively as the optimal cut-off value was 4. 18. Conclusions Increased NLR in early peripheral blood may effectively predict LVO in acute ischemic stroke.