中性粒细胞/淋巴细胞比值、NIHSS评分和侧支循环Tan评分联合预测前循环大血管闭塞性卒中患者静脉溶栓转归

Combination of neutrophil to lymphocyte ratio,NIHSS score and collateral circulation Tan score predicts the outcome of intravenous thrombolysis in patients with anterior circulation large vessel occlusive stroke

目的:探讨溶栓前外周血中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分联合侧支循环Tan评分对急性前循环大血管闭塞性卒中患者静脉溶栓转归的预测价值。方法:回顾性纳入2019年1月至2021年5月期间在安徽医科大学第二附属医院神经内科接受阿替普酶静脉溶栓治疗的急性前循环大血管闭塞性卒中患者。在溶栓后90 d应用改良Rankin量表进行转归评价,0~2分定义为转归良好,3~6分定义为转归不良。比较转归良好组与转归不良组人口统计学、临床资料和影像学资料的差异。采用多变量logistic回归分析确定静脉溶栓转归的独立影响因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、NIHSS评分、Tan评分及三者联合对静脉溶栓转归的预测价值。结果:研究期间共纳入118例急性前循环大血管闭塞性卒中患者,年龄(67.73±11.91)岁,男性71例(60.2%)。转归良好组58例(49.2%),转归不良组60例(50.8%)。单变量分析显示,转归良好组的NLR、侧支循环Tan评分和基线NIHSS评分与转归不良组存在显著统计学差异(P均<0.05)。多变量logistic回归分析显示,NLR[优势比(odds ratio,OR)1.299,95%置信区间(confidence interval,CI)1.005~1.679;P=0.046]、基线NIHSS评分(OR 1.150,95%CI 1.037~1.275;P=0.008)、侧支循环Tan评分(OR 0.298,95%CI 0.0.160~0.556;P=0.000)与转归独立相关。ROC曲线分析表明,NLR、基线NIHSS评分、Tan评分及三者联合预测转归不良的曲线下面积分别为0.640、0.752、0.823和0.870。结论:溶栓前外周血NLR、基线NIHSS评分及侧支循环Tan评分均可预测急性前循环大血管闭塞性卒中患者的静脉溶栓后转归,且三者联合的预测价值更高。

Objective:To investigate the predictive value of baseline peripheral blood neutrophil to lymphocyte ratio(NLR),National Institutes of Health Stroke Scale(NIHSS)score combined with collateral circulation Tan score for the outcome of intravenous thrombolysis in patients with acute anterior circulation large vessel occlusive stroke.Methods:Patients with acute anterior circulation large vessel occlusive stroke received alteplase intravenous thrombolysis in the Departmet of Neurology,the Second Affiliated Hospital of Anhui Medical University from January 2019 to May 2021 were enrolled retrospectively.The modified Rankin Scale score was used to evaluate the outcomes at 90 d after thrombolysis.0-2 was defined as good outcome and 3-6 were defined as poor outcome.The demographics,clinical data and imaging data between the good outcome group and the poor outcome group were compared.Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome of thrombolysis,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR,NIHSS score,Tan score and their combination on the outcome of intravenous thrombolysis.Results:A total of 118 patients with acute anterior circulation large vessel occlusive stroke were enrolled during the study.Their age was 67.73±11.91 years,and there were 71 males(60.2%).Fifty-eight patients(49.2%)were in the good outcome group and 60(50.8%)were in the poor outcome group.Univariate analysis showed that there were significant differences in NLR,collateral circulation Tan score and baseline NIHSS score between the good outcome group and the poor outcome group(all P<0.05).Multivariate logistic regression analysis showed that NLR(odds ratio[OR]1.299,95%confidence interval[CI]1.005-1.679;P=0.046),baseline NIHSS score(OR 1.150,95%CI 1.037-1.275;P=0.008),collateral circulation Tan score(OR 0.298,95%CI 0.160-0.556;P<0.001)were independently associated with the outcomes.ROC curve analysis showed that the areas under the curve of NLR,baseline NIHSS score,Tan score and their combination for predicting poor outcome were 0.640,0.752,0.823 and 0.870,respectively.Conclusions:Peripheral blood NLR before thrombolysis,baseline NIHSS score and collateral circulation Tan score could predict the outcomes after intravenous thrombolysis in patients with acute anterior circulation large vessel occlusive stroke,and the combination of the three had a higher predictive value.