急性脑梗死患者静脉溶栓前中性粒细胞百分比与溶栓后临床结局的关系

The relationship between neutrophil ratio before thrombolysis of acute ischemic stroke patients and their clinical outcome after thrombolysis

目的探讨急性脑梗死患者静脉溶栓前中性粒细胞百分比与溶栓后临床结局的关系。方法回顾性分析2017年8月~2019年8月我院神经内科接受静脉溶栓治疗的118例急性脑梗死患者。早期神经功能恶化定义为溶栓后24 h美国国立卫生研究院脑卒中量表(NIHSS)评分较溶栓前升高≥4分,预后不良定义为3个月改良Rankin评分>2分。采用二元Logistic回归分析早期神经功能恶化、预后不良和3个月内死亡的独立危险因素。结果18例(15.3%)发生早期神经功能恶化,55例(46.6%)预后不良,23例(19.5%)3个月内死亡。Logistic回归分析提示:中性粒细胞百分比(OR=1.058,95%CI=1.006~1.112)和溶栓前NIHSS评分(OR=1.099,95%CI=1.019~1.186)均为早期神经功能恶化的独立危险因素(P<0.05);矫正NIHSS评分(OR=1.251,95%CI=1.145~1.366)后,中性粒细胞百分比(OR=1.049,95%CI=1.009~1.091)仍是3个月内预后不良的独立危险因素(P<0.05);房颤(OR=3.600,95%CI=1.079~12.017)、中性粒细胞百分比(OR=1.068,95%CI=1.012~1.127)和溶栓前NIHSS评分(OR=1.177,95%CI=1.068~1.297)是溶栓后3个月内死亡的独立危险因素(P<0.05)。结论急性脑梗死患者静脉溶栓前中性粒细胞百分比对静脉溶栓后临床结局有一定预测价值。

Objective To explore the relationship between the percentage of neutrophils before intravenous thrombolysis and clinical outcome after thrombolysis in patients with acute cerebral infarction.Methods A retrospective analysis of 118 patients with acute cerebral infarction who received intravenous thrombolysis in department of neurology in our hospital from August 2017 to August 2019.Early neurological deterioration was defined as at 24 h after thrombolysis the National Institutes of Health Stroke scale(NIHSS)score increased by≥4 points before thrombolysis,and the poor prognosis was defined as a modified Rankin score of 3 months>2 points.Binary Logistic regression was used to analyze the independent risk factors of early neurological deterioration,poor prognosis and death within 3 months.Results There were 18 patients(15.3%)had early neurological deterioration,55 patients(46.6%)had poor prognosis,and 23 patients(19.5%)died within 3 months.Logistic regression analysis showed that the percentage of neutrophils(OR=1.058,95%CI=1.006-1.112)and NIHSS score before thrombolysis(OR=1.099,95%CI=1.019-1.186)were independent risk factors for early neurological deterioration(P<0.05);after correcting NIHSS score(OR=1.251,95%CI=1.145-1.366),the percentage of neutrophils(OR=1.049,95%CI=1.009-1.091)was still an independent risk factor for poor prognosis within 3 months(P<0.05);atrial fibrillation(OR=3.600,95%CI=1.079-12.017),percentage of neutrophils(OR=1.068,95%CI=1.012-1.127)and NIHSS score before thrombolysis(OR=1.177,95%CI=1.068-1.297)were independent risk factors for death within 3 months after thrombolysis(P<0.05).Conclusion The percentage of neutrophils before intravenous thrombolysis in patients with acute cerebral infarction has a certain predictive value for the clinical outcome after intravenous thrombolysis.