急性脑梗死静脉溶栓患者NLR及PNR的动态变化与预后的相关性研究

Study on the correlation between the dynamic changes of NLR and PNR and prognosi in patients with acute cerebral infarction and intravenous thrombolysis

目的探索急性脑梗死静脉溶栓患者血中性粒细胞和淋巴细胞比值(NLR)和血小板与中性粒细胞比值(PNR)的动态变化与预后的相关性。方法收集2019年9月—2020年8月徐州医科大学附属医院急诊就诊的急性脑梗死发病4.5 h内接受阿替普酶静脉溶栓治疗患者的临床资料。根据溶栓前后NLR和PNR的动态变化分为NLR升高组和NLR降低组、PNR升高组和PNR降低组,观察记录各组患者全因死亡、脑出血的发生及溶栓后90 d神经功能,探讨NLR及PNR的动态变化与不良预后的相关性。结果共纳入患者114例,其中NLR升高组58例,NLR降低组56例,与NLR降低组相比,NLR升高组具有较高的mRS评分(P<0.001)、全因死亡率(P=0.001)、脑出血发生率(P=0.017)和较低的Barthel指数(P=0.02),并且溶栓后NLR升高(OR=0.44,95%CI:0.26~0.77,P=0.004)是脑卒中患者90 d预后不良的独立危险因素;PNR升高组57例,PNR降低组57例,与PNR组升高组相比,PNR降低组具有较高mRS评分(P<0.001)、全因死亡率(P=0.020)、脑出血发生率(P=0.014)及较低的Barthel指数(P=0.011),并且溶栓后PNR降低(OR=2.06,95%CI:1.23~3.45,P=0.006)是脑卒中患者90 d预后不良的独立危险因素。结论静脉溶栓后NLR升高、PNR降低与脑卒中患者90 d预后不良相关。

Objective To investigate the correlation between the dynamic changes of blood neutrophil to lymphocyte ratio(nlr)and platelet to neutrophil ratio(PNR)and prognosis in patients with acute cerebral infarction and intravenous thrombolysis.Methods Clinical data of patients receiving intravenous thrombolysis with alteplase within 4.5 h after onset from January 2019 to August 2020 were collected.Based on the dynamic changes of NLR and PNR before and after thrombolysis,patients were divided into increased NLR group and decreased NLR group,increased PNR group and decreased PNR group.The cerebral hemorrhage,all-cause death and neurological function at 90 days after thrombolysis were observedto explore the correlation between the dynamic changes of NLR and PNR and poor prognosis.Results 114 patients were included,with 58 patients assigned to the increased NLR group and 56 assigned to the decreased NLR group.Compared with thedecreased NLR group,the increased NLR group had higher mRS score(P<0.001),allcause mortality(P=0.001),incidence of intracerebral hemorrhage(P=0.017),and lower Barthel index(P=0.02).Moreover,the increased NLR after thrombolysis(OR=0.44,95%CI:0.26~0.77,P=0.004)was an independent risk factor for poor prognosis in stroke patients at 90 days.What's more,114 patients were equally divided into increased PNR groupand decreased PNR group.Compared with the increased PNR group,the decreased PNR group had higher mRS score(P<0.001),all-cause mortality(P=0.02),incidence of cerebral hemorrhage(P=0.014)and lower Barthel index(P=0.011).Moreover,the decreased PNR after thrombolysis(OR=2.24,95%CI:1.45~3.46,P<0.001)was an independent risk factor for poor prognosis in stroke patients at 90 days.Conclusion Increased NLR and decreased PNR after intravenous thrombolysis were associated with poor prognosis in stroke patients at 90 days.