NLR、PLR、hs-CRP、Hb、D-D与脑梗死非溶栓治疗后出血性转化的关系

Relationship between NLR,PLR,hs-CRP,Hb,D-D and Hemorrhagic Transformation after Non Thrombolytic Treatment of Cerebral Infarction

目的:探讨血红蛋白(Hb)、血小板/淋巴细胞(PLR)、D-二聚体(D-D)、超敏C反应蛋白(hs-CRP)、中性粒细胞/淋巴细胞(NLR)与脑梗死非溶栓治疗后出血性转化(HT)的关系。方法:回顾性分析2017年1月-2020年12月漳州市第二医院收治的50例接受非溶栓治疗后出现HT的脑梗死患者的临床资料,将其设为研究组,另选取同期于本院接受非溶栓治疗后未发生HT的脑梗死患者50例设为对照组。对比两组血清Hb、PLR、D-D、hs-CRP、NLR水平。根据患者转归情况将研究组分为预后良好组、预后不良组,对比两组血清Hb、PLR、D-D、hs-CRP、NLR水平。应用受试者工作曲线(ROC)分析上述血清因子对脑梗死非溶栓治疗后HT的预测价值。结果:研究组血清Hb、D-D低于对照组,血清hs-CRP、NLR高于对照组(P<0.05)。ROC分析发现,血清Hb、NLR、D-D、hs-CRP均对HT有一定的预测价值,预测HT的cut-off值分别为127.21 g/L、6.15、321.34 μg/L、9.99 mg/L,且上述指标联合预测HT的敏感度高于单项预测(χ^(2)=15.946、9.470、4.891、1.042,P=0.000、0.002、0.027、0.307);特异度与单项评估对比,差异有统计学意义(χ^(2)=13.636、40.845、17.647、6.330,P=0.000、0.000、0.000、0.012),AUC高于单项预测(Z=2.306、0.338、0.182、0.018,P=0.020、0.561、0.067、0.894)。预后不良组血清Hb低于预后良好组,血清hs-CRP、NLR高于预后良好组(P<0.05)。结论:血清Hb、NLR、D-D、hs-CRP的异常表达均可提示HT发生,联合检测上述指标对HT的预测效能更高,血清Hb、hs-CRP、NLR的异常表达可提示HT患者转归不良,临床应加强监测上述指标。

Objective:To investigate the relationship between hemoglobin (Hb),platelet/lymphocyte rate (PLR),D-dimer (D-D),high-sensitivity C reactive protein (hs-CRP),neutrophil/lymphocyte rate (NLR) and hemorrhagic transformation (HT) after non thrombolytic treatment of cerebral infarction.Method:The clinical data of 50 patients with cerebral infarction who developed HT after receiving non thrombolytic therapy in Zhangzhou Second Hospital from January 2017 to December 2020 were retrospectively analyzed,and they were set as the study group,another 50 patients with cerebral infarction who did not develop HT after receiving non thrombolytic therapy in our hospital during the same period were selected as the control group.The levels of serum Hb,PLR,D-D,hs-CRP and NLR between the study group and the control group were compared.According to the outcome of the patients,the study group was divided into good prognosis group and poor prognosis group.The levels of serum Hb,PLR,D-D,hs-CRP and NLR between the good prognosis group and poor prognosis group were compared.Receiver operating curve (ROC) was used to analyze the predictive value of the above serum factors for HT after non thrombolytic treatment of cerebral infarction.Result:The serum Hb and D-D in the study group were lower than those in the control group,and the serum hs-CRP and NLR were higher than those in the control group (P<0.05).ROC analysis revealed that serum Hb,NLR,D-D,and hs-CRP all had some predictive value for HT,and the cut-off values for predicting HT were 127.21 g/L,6.15,321.34 μg/L,and 9.99 mg/L respectively,and the sensitivity of combined prediction of HT by the above indicators was higher than that of single prediction (χ^(2)=15.946,9.470,4.891,1.042,P=0.000,0.002,0.027,0.307),the difference between specificity and single evaluation was statistically significant (χ^(2)=13.636,40.845,17.647,6.330,P=0.000,0.000,0.000,0.012).AUC was higher than single prediction (Z=2.306,0.338,0.182,0.018,P=0.020,0.561,0.067,0.894).The serum Hb in the poor prognosis group was lower than that in the good prognosis group,the serum hs-CRP and NLR were higher than those in the good prognosis group (P<0.05).Conclusion:The abnormal expression of serum Hb,NLR,D-D and hs-CRP can indicate the occurrence of HT.The combined detection of the above indicators has a higher predictive effect on HT.The abnormal expression of serum Hb,hs-CRP and NLR can indicate the poor prognosis of HT patients.The clinical monitoring of the above indicators should be strengthened.