溶栓后中性粒细胞与淋巴细胞比值对急性缺血性脑卒中预后的评估价值

Value of neutrophil-to-lymphocyte ratio after intravenous thrombolytic therapy in judging prognosis of patients with acute ischemic stroke

目的探讨阿替普酶(rt-PA)静脉溶栓治疗后24 h内中性粒细胞与淋巴细胞比值(NLR)水平对急性缺血性脑卒中(AIS)患者90 d预后的影响。方法回顾性分析经rt-PA静脉溶栓治疗的AIS患者的临床资料,以90 d时改良Rankin量表(mRS)评分以及死亡作为疗效指标,将患者分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分>2分及死亡),应用多因素Logistic回归分析探讨溶栓后预后的独立危险因素,并采用受试者工作特征(ROC)曲线评价溶栓治疗后NLR水平对AIS静脉溶栓患者预后的预测价值。结果多因素Logistic回归分析显示,溶栓治疗后NLR及溶栓前NIHSS评分是预后不良的独立危险因素,溶栓治疗后NLR对AIS患者预后不良的诊断界值为0.769,敏感性为80.00%,特异性为73.80%。结论溶栓治疗后24 h内NLR是预测AIS溶栓患者预后的良好指标。

Objective To investigate the effect of recombinant tissue plasminogen activator(rt-PA)on neutrophil-to-lymphocyte ratio(NLR)within 24 h on 90 d prognosis in patients with acute ischemic stroke(AIS)after intravenous thrombolytic therapy by rt-PA.Methods The clinical data of patients with AIS treated by intravenous thrombolytic therapy with rt-PA was retrospectively analyzed.The modified Rankin Scale(mRS)score and death condition at 90 d were used as the curative effect index.The patients were divided into good prognosis group(mRS score≤2)and poor prognosis group(mRS score>2 and the death).Multivariate Logistic regression analysis was used to investigate the independent risk factors for prognosis after thrombolysis,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of NLR level after thrombolysis for the prognosis of patients with AIS.Results The multivariate Logistic regression analysis showed that NIHSS score before thrombolytic therapy and NLR after thrombolytic therapy were both independent risk factors for poor prognosis.After thrombolytic therapy,the diagnostic threshold value of NLR for poor prognosis of AIS patients was 0.769,the sensitivity was 80.00%and the specificity was 73.80%.Conclusion The level of NLR within 24 h after thrombolytic therapy is a good index to predict the prognosis of patients with AIS thrombolytic therapy.