伴有卒中相关性肺炎的老年新发脑卒中患者外周血中性粒细胞与淋巴细胞比值的变化及临床意义

Changes and Clinical Significance of the Ratio of Peripheral Blood Neutrophils to Lymphocytes in Elderly Patients with Stroke Associated Pneumonia

目的探讨伴有卒中相关性肺炎(stroke associated pneumonia,SAP)的老年新发脑卒中患者外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)的变化及临床意义。方法回顾性纳入2019年9月-2020年12月在牡丹江医学院附属红旗医院神经内科住院的老年新发急性缺血性卒中患者。SAP 61例,未发生SAP 254例。两组患者在入院后48 h内进行血常规、C反应蛋白、肝肾功能、空腹血糖、血脂水平、同型半胱氨酸等检查。比较两组患者基线资料以及NLR的差异,通过绘制ROC曲线评价NLR对SAP的预测价值。结果老年新发脑卒中患者发生SAP组及非SAP组人口统计学及基线资料进行了比较,SAP组白细胞计数、中性粒细胞值、NLR、吞咽困难、NIHSS评分、年龄均高于非SAP组,淋巴细胞数低于SAP组。多变量Logistic回归分析显示,NLR(OR 1.508,95%CI 1.291~1.762,P<0.001)、吞咽困难(OR 2.972,95%CI 1.239~7.132,P=0.015)、NIHSS评分(OR 1.383,95%CI 1.238~1.544,P<0.001)和年龄(OR 1.036,95%CI 1.002~1.070,P=0.027)是发生SAP的独立危险因素。ROC曲线分析显示,NLR预测SAP的曲线下面积为0.745(95%CI 0.679~0.812,P<0.001);当NLR联合吞咽困难评分预测SAP曲线下面积0.750(95%CI 0.682~0.819,P<0.001);当NLR联合年龄评分预测SAP曲线下面积0.757(95%CI 0.691~0.822,P=0.033);当NLR联合NIHSS评分预测SAP曲线下面积0.858(95%CI 0.805~0.911,P=0.027)。结论检查NLR的变化对SAP的患者具有明显的预测价值。

Objective To investigate the changes and clinical significance of peripheral blood neutrophil to lymphocyte ratio(NLR)in elderly patients with stroke associated pneumonia(SAP).Methods The elderly patients with new acute ischemic stroke hospitalized in the Department of Neurology of Hongqi Hospital of Mudanjiang Medical University from September 2019 to December 2020 were retrospectively included.There were 61 cases of SAP and 254 cases without SAP.Blood routine,CRP,liver and kidney function,fasting blood glucose,blood lipid level and homocysteine were examined within 48 hours after admission.The baseline data and NLR were compared between the two groups.The predictive value of NLR in peripheral blood to SAP was evaluated by drawing the ROC curve.Results The demographic and baseline data of SAP group and non-SAP group were compared.The leukocyte count,neutrophil value,NLR,dysphagia,NIHSS score and age in SAP group were higher than those in non-SAP group,and the number of lymphocytes in SAP group was lower than that in SAP group.Multivariate logistic regression analysis showed that NLR(OR 1.508,95% CI 1.291-1.762,P<0.001),dysphagia(OR 2.972,95% CI 1.239-7.132,P=0.015),NIHSS score(OR 1.383,95% CI 1.238-1.544,P<0.001)and age(OR 1.036,95% CI 1.002-1.070,P=0.027)was an independent risk factor for SAP.ROC curve analysis showed that NLR predicted the area under the curve of SAP as 0.745(95% CI 0.679-0.812,P<0.001),when NLR combined with dysphagia score predicted the area under the curve of SAP as 0.750(95%CI 0.682-0.819,P<0.001),when NLR combined with age score predicted the area under the curve of SAP as 0.757(95% CI 0.691-0.822,P=0.033),and when NLR combined with NIHSS score predicted the area under the sap curve SAP as of 0.858(95% CI 0.805-0.911,P=0.027).Conclusion The change of NLR in peripheral blood has an obvious predictive value for patients with SAP.