全身免疫炎症指数及D-二聚体与青年急性脑梗死患者的病情严重程度及预后的关系

Study on the relationship between systemic immune inflammation index and D-dimer and the severity and prognosis of young acute cerebral infarction patients

目的探讨全身免疫炎症指数(SII)、D-二聚体(D-D)与青年急性脑梗死患者病情严重程度及预后的关系。方法纳入2019年3月至2021年3月徐州医科大学附属医院神经内科收治的182例青年急性脑梗死患者,根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组(143例)与中重度组(39例);根据梗死灶体积分为小体积组(77例)、中体积组(75例)、大体积组(30例)。3个月后随访,根据改良Rankin量表(mRS)评分分为预后良好组(131例)与预后不良组(51例)。分析SII、D-D等指标与脑梗死严重程度、梗死灶体积及预后的关系,进一步行影响脑梗死预后的多因素Logistic回归分析,并且采用受试者工作特征(ROC)曲线评价SII、D-D的敏感度及特异度,确定诊断最佳截断值。结果在青年急性脑梗死患者中,中重度患者的SII、D-D水平高于轻度组,差异有统计学意义[分别为1019.27(763.11,2538.15)比578.20(398.63,886.49)、0.41(0.19,0.86)μg/L比0.18(0.09,0.34)μg/L,P<0.05]。梗死灶大体积组的SII水平分别高于小体积组、中体积组,差异有统计学意义[分别为1187.28(730.05,2251.80)比565.13(369.81,741.89)、696.25(441.22,1072.71),P<0.05],梗死灶大体积组的D-D水平高于小体积组,差异有统计学意义[0.36(0.18,0.89)μg/L比0.15(0.07,0.34)μg/L,P<0.05]。Logistic回归分析显示,SII升高、D-D升高是预后不良的独立危险因素(P<0.05)。ROC分析SII及D-D值预测青年脑梗死患者预后不良的曲线下面积(AUC)分别为0.789(95%CI:0.712~0.866)和0.757(95%CI:0.681~0.833),且血清SII、D-D预测青年急性脑梗死患者预后不良的最佳截断值分别为781.40、0.16μg/L。结论青年急性脑梗死患者的SII及D-D水平与病情严重程度、脑梗死体积相关,并对短期预后具有一定的预测价值。

Objective To investigate the relationship between systemic immune inflammatory index(SII),D-Dimer(D-D)and the severity and prognosis of young patients with acute cerebral infarction.Methods A total of 182 young patients with acute cerebral infarction treated in the Department of Neurology of the Affiliated Hospital of Xuzhou Medical University from March 2019 to March 2021 were recruited.All the research subjects were divided into mild group(143 cases)and moderate/severe group according to National Institutes of Health Stroke Scale(NIHSS)score.According to the infarct volume,they were divided into small volume group(77 cases),medium volume group(75 cases)and large volume group(30 cases).After 3 months of follow-up,according to the modified Rankin Scale(mRS)score,they were divided into good prognosis group(131 cases)and poor prognosis group(51 cases).The relationship between SII,D-D and the severity of cerebral infarction,the volume of infarct focus and prognosis was analyzed.The multivariate Logistic regression analysis affecting the prognosis of cerebral infarction was further carried out.The sensitivity and specificity of SII and D-D were evaluated by receiver operating characteristic curve(ROC),and the best cut-off value was determined.Results In young patients with acute cerebral infarction,the levels of SII and D-D in patients with moderate/severe neurological deficit were significantly higher than those in mild group[1019.27(763.11,2538.15)vs 578.20(398.63,886.49),0.41(0.19,0.86)μg/L vs 0.18(0.09,0.34)μg/L,P<0.05].The level of SII in the large volume group was higher than that in the small volume group and the medium volume group[1187.28(730.05,2251.80)vs 565.13(369.81,741.89),696.25(441.22,1072.71),P<0.05].The level of D-D in the large volume group was higher than that in the small volume group[0.36(0.18,0.89)μg/L vs 0.15(0.07,0.34)μg/L,P<0.05].Logistic regression analysis showed that the increase of SII and D-D were independent risk factors for poor prognosis(P<0.05).The area under the curve(AUC)of SII and D-D in ROC analysis to predict the poor prognosis of young patients with cerebral infarction were 0.789(95%CI:0.712-0.866)and 0.757(95%CI:0.681-0.833),respectively.The best critical values of serum SII and D-D to predict the poor prognosis of young patients with acute cerebral infarction were 781.4 and 0.16μg/L,respectively.Conclusions The levels of D-D and SII in young patients with acute cerebral infarction are related to the severity of the disease and the volume of cerebral infarction,and have a certain predictive value for the shortterm prognosis.