急性缺血性脑卒中患者血运重建前后NLR 值与预后相关性分析

Correlation between NLR Value and Prognosis in Patients with Acute Ischemic Stroke before and after Revascularization

目的通过研究急性缺血性脑卒中血运重建前后与预后不良有关的影响因素,以期为临床医师预测患者预后提供更多的生物学标志物。方法收集2020年12月至2021年10月昆明医科大学附属曲靖医院神经内科及神经介入科收治的急性缺血性脑卒中并接受血运重建治疗(包括静脉溶栓、机械取栓切除术或者2者均行)的患者179例,根据3个月后mRS评分分为预后良好组(mRS<3分)和预后不良组(mRS≥3分)。比较2组患者的一般资料、临床检验指标、血运重建前后NLR值、NIHSS评分等,并进一步分析预后不良组患者的独立危险因素。结果(1)预后良好与预后不良2组患者的甘油三酯、总胆固醇、C反应蛋白、入院的NIHSS评分、中性粒细胞数及百分比、淋巴细胞数及百分比、NLR值及血运重建后8h的白细胞、中性粒细胞数及百分比、淋巴细胞数与百分比、NLR值,差异具有统计学意义(P<0.05);(2)多因素Logistic回归分析,入院NIHSS评分(OR=1.123,95%CI 1.065~1.184,P<0.05)是AIS患者血运重建后3个月预后不良的独立危险因素,临床诊断分界值为11;(3)NLR值比较:预后不良组血运重建前后的NLR值均高于预后良好组,差异有统计学意义(P<0.05),AIS患者血运重建后NLR值较血运重建前升高,差异有统计学意义(P<0.05)。结论入院时的NIHSS评分是AIS血运重建患者发病3个月不良预后的独立危险因素。AIS患者血运重建前后NLR变化具有上升趋势,预后不良组血运重建前后的NLR高于预后良好组,但并非AIS患者血运重建3个月后不良预后的独立危险因素。

Objective To study the influencing factors of poor prognosis before and after revascularization of acute ischemic stroke,so as to provide more biomarkers for prognosis prediction.Methods A total of 179 patients with acute ischemic stroke who received revascularization therapy(including intravenous thrombolysis,mechanical thrombectomy,or both)admitted to the Department of Neurology and The Department of Neurointervention of Qujing Hospital Affiliated to Kunming Medical University from December 2020 to October 2021 were collected.According to mRS score after 3 months,the patients were divided into good prognosis group(mRS<3)and poor prognosis group(mRS≥3).General data,clinical test indicators,NLR value and NIHSS score before and after revascularization were compared between the two groups,and independent risk factors of patients with poor prognosis were further analyzed.Results There are siginificant differences in triglyceride,total cholesterol,creactive protein,NIHSS score,the number of neutrophils and percentage of the hospital,lymphocyte count and percentage,NLR value and reascularization 8 hours after the number of white blood cells,neutrophils and percentage,lymphocyte count and percentage,NLR value between the two groups(P<0.05).Multivariate Logistic regression analysis showed that admission NIHSS score(OR=1.123,95%CI 1.065-1.184,P<0.05)was an independent risk factor for poor prognosis 3 months after revascularization in AIS patients,with a clinical diagnostic cut-off value of 11.The NLR values of the poor prognosis group before and after revascularization were higher than those of the good prognosis group,the difference was statistically significant(P<0.05).The NLR values of AIS patients after revascularization were higher than those before revascularization,the difference was statistically significant(P<0.05).Conclusion NIHSS score at admission is an independent risk factor for poor prognosis at 3 months in patients with AIS revascularization.Changes in NLR in AIS patients before and after revascularization showed an upward trend,and NLR in the poor prognosis group was higher than that in the good prognosis group before and after revascularization,but it was not an independent risk factor for poor prognosis in AIS patients 3 months after revascularization.