老年急性缺血性卒中患者外周血炎性指标与颅内显著动脉粥样硬化狭窄数量相关性分析

Analysis of correlation between peripheral blood inflammatory markers and the number of significant intracranial atherosclerotic stenosis in elderly patients with acute ischemic stroke

目的:检测老年急性缺血性卒中(acute ischemic stroke,AIS)患者外周血炎性指标的变化并分析其与颅内显著动脉粥样硬化狭窄(significant atherosclerotic stenosis,SAS)数量的相关性。方法:连续纳入2021年8月1日至2021年12月31日于江苏大学附属医院神经内科诊治的>60岁大动脉粥样硬化型和小动脉闭塞型AIS患者,实验室检查检测生化指标,血常规检测炎性指标包括白细胞计数、中性粒细胞计数、单核细胞计数、淋巴细胞计数及中性粒细胞/淋巴细胞比值(NLR)。磁共振血管成像评估颅内SAS(≥50%狭窄或闭塞),根据颅内SAS数量将AIS患者分为无SAS组(n=77)、单支SAS组(n=45)和多支(≥2)SAS组(n=33),比较3组临床特征包括生化及炎性指标。采用多因素logistic回归分析颅内SAS数量与炎性指标的相关性。按照颅内SAS最严重狭窄程度将78例存在SAS的受试者分为3组:中度狭窄组(n=23)、重度狭窄组(n=17)和闭塞组(n=38),比较3组炎性指标;Spearman秩相关分析炎性指标与颅内SAS数量的相关性。结果:与无SAS和(或)单支SAS组相比,多支SAS组年龄、白细胞计数、中性粒细胞计数及NLR均显著增高(P均<0.05)。多因素logistic回归分析结果显示,颅内SAS数分别与高白细胞计数、高中性粒细胞计数、高NLR独立相关(P均<0.05)。中度狭窄、重度狭窄及闭塞组各炎性指标比较差异均无统计学意义(P均>0.05)。Spearman相关性分析结果显示,白细胞计数、中性粒细胞计数与颅内SAS数量呈弱相关(r=0.255,P=0.024;r=0.319,P=0.004)。结论:老年AIS患者外周血炎性指标表现为白细胞计数、中性粒细胞计数及NLR增高,且与颅内SAS数量呈一定的弱相关。

Objective:To detect the changes of inflammatory markers in peripheral blood of elderly patients with acute ischemic stroke(AIS)and analyze their correlation with the number of significant atherosclerotic stenosis(SAS)in the brain.Methods:Patients elder than 60 years with AIS of large artery atherosclerosis and small artery occlusion subtypes hospitalized in Department of Neurology,Affiliated Hospital of Jiangsu University from August 1st,2021 to December 31th,2021 were consecutively enrolled in the study.Biochemical indicators were tested by laboratory examination.Peripheral inflammatory indices were collected via routine blood tests,including leukocyte count,neutrophil count,monocyte count,lymphocyte count,and neutrophil-to-lymphocyte ratio(NLR).Intracranial SAS was evaluated by magnetic resonance angiography(MRA),which was defined as≥50%stenosis or occlusion.The subjects were divided into three groups based on the number of intracranial SAS:no SAS(n=77),single SAS(n=45)and multiple(≥2)SAS group(n=33);and the clinical characteristics including biochemical indicators and inflammatory markers were compared among the three groups.Multivariate logistic regression was used to analyze the correlation between the number of intracranial SAS and inflammatory markers.According to the most severe stenosis of intracranial SAS,78 subjects with SAS were divided into 3 groups:moderate stenosis group(n=23),severe stenosis group(n=17)and occlusion group(n=38).Inflammatory markers of three groups were compared.Spearman rank correlation was used to analyse the correlation between inflammatory indexes and the number of intracranial SAS.Results:Compared with the non-SAS and/or single-vessel SAS group,the age,white blood cell count,neutrophil count and NLR in the multi-vessel SAS group were significantly increased(all P<0.05).Multivariate logistic regression analysis showed that the number of intracranial SAS was independently correlated with high white blood cell count,high and medium neutrophil count,and high NLR(all P<0.05).There was no significant difference in the inflammatory indexes between the moderate stenosis,severe stenosis and occlusion groups(all P>0.05).The results of Spearman correlation analysis showed that white blood cell count and neutrophil count were weakly correlated with the number of intracranial SAS(r=0.255,P=0.024;r=0.319,P=0.004).Conclusion:Peripheral blood inflammatory indicators in elderly patients with AIS showed increased white blood cell count,neutrophil count and NLR,which were weakly correlated with the number of intracranial SAS.