急性前循环大血管闭塞机械取栓时首通效应与NLR的关系

Relationship between first pass effect during mechanical thrombectomy and neutrophil to lymphocyte ratio in acute anterior circulation large vessel occlusive stroke

目的探讨急性前循环大血管闭塞性卒中患者机械取栓时首通效应(FPE)与中性粒细胞与淋巴细胞比值(NLR)的关系。方法选择郑州大学人民医院介入中心脑血管病科自2018年1月至2021年6月收治并采用机械取栓治疗的406例急性前循环大血管闭塞性卒中患者进入研究,根据首次取栓后血管是否完全再通将患者分为FPE组(186例)和非FPE组(220例)。收集并比较2组患者一般资料、临床特征及手术相关数据,将单因素分析中P<0.05的因素纳入多因素Logistics回归分析中,明确影响FPE的独立因素;同时绘制受试者工作特征(ROC)曲线,比较各项因素预测FPE的效能。结果单因素分析结果显示,2组患者性别、侧支循环等级分布、中性粒细胞计数、淋巴细胞计数、血小板与淋巴细胞比值(PLR)和NLR差异均有统计学意义(P<0.05)。与非FPE组患者相比,FPE组患者入院Alberta卒中项目早期CT评分(ASPECTS)明显升高,股动脉穿刺到再通时间明显缩短,血管再通比例、使用球囊导引导管比例明显升高,造影剂外渗比例、症状性颅内出血(sICH)和死亡率发生率明显降低,术后90 d预后良好率明显升高,差异均有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,性别(OR=0.686,95%CI:1.131~3.491,P=0.017)、入院ASPECTS评分(OR=0.143,95%CI:0.094~0.220,P<0.001)、NLR(OR=1.722,95%CI:1.413~2.098,P<0.001)和PLR(OR=1.007,95%CI:1.003~1.014,P<0.001)是影响FPE的独立因素。ROC曲线结果显示,性别、入院ASPECTS评分、PLR、NLR及多因素联合(性别+入院ASPECTS评分+PLR+NLR)预测FPE的曲线下面积分别为0.60、0.17、0.71、0.77、0.91;NLR在单因素预测FPE时效能最高,截断值为5.86时,特异性为83.3%,敏感性为62.3%。结论急性前循环大血管闭塞性卒中患者入院时NLR较高易导致机械取栓治疗时FPE失败。

Objective To explore the relationship between neutrophil to lymphocyte ratio(NLR)and first pass effect(FPE)during mechanical thrombectomy in patients with acute anterior circulation large vessel occlusive stroke.Methods Four hundred and six patients with acute anterior circulation large vessel occlusive stroke,admitted to and received mechanical thrombectomy in our hospital from January 2018 to June 2021,were chosen in our study.They were divided into FPE group(n=186)and non-FPE group(n=220)according to whether the occluded vessels were successfully or completely re-canalized after the first mechanical thrombectomy.The baseline data,clinical characteristics and operation related data were recorded and compared.The factors with P<0.05 in univariate analysis were included in multivariate Logistic regression analysis to identify the independent factors for FPE.The receiver operating characteristic(ROC)curve was plotted to compare the effectiveness of various factors in predicting FPE.Results Univariate analysis showed that there were significant differences in gender,proportion of different collateral circulation grading,neutrophil count,lymphocyte count,platelet to lymphocyte ratio(PLR),and NLR between the two groups(P<0.05).As compared with non-FPE group,FPE group had significantly higher ASPECTS scores at admission,significantly shorter time from femoral artery puncture to recanalization,significantly higher proportion of vascular recanalization,statistically higher proportion of patients using balloon guiding catheter,significantly lower ratio of contrast extravasation,significantly lower incidences of spontaneous intracerebral hemorrhage and mortality,and statistically higher rate of good prognosis 90 d after surgery(P<0.05).The results of multivariate Logistics regression analysis showed that gender(OR=0.686,95%CI:1.131-3.491,P=0.017),ASPECTS scores(OR=0.143,95%CI:0.094-0.220,P<0.001),NLR(OR=1.722,95%CI:1.413-2.098,P<0.001),and PLR(OR=1.007,95%CI:1.003-1.014,P<0.001)were independent factors for FPE.ROC curve results showed that the areas under the curve predicted by gender,ASPECTS scores,PLR,NLR and combination of multiple factors(gender+ASPECTS scores+PLR+NLR)were 0.60,0.17,0.71,0.77 and 0.91,respectively;among them,NLR had the highest efficacy in single-factor prediction for FPE,with cut-off value of 5.86,specificity of 83.3%,and sensitivity of 62.3%.Conclusion High NLR at admission in patients with acute anterior circulation large vessel occlusive stroke is likely to have FPE failure during mechanical thrombectomy.