血浆NLR联合NIHSS评分对老年急性脑梗死静脉溶栓后预后的预测价值

Prognostic value of plasma NLR combined with NIHSS score in elderly patients with acute cerebral infarction after intravenous thrombolysis

目的探讨中性粒细胞/淋巴细胞值(neutrophil to lymphocyte ratio,NLR)联合NIHSS评分对老年急性脑梗死(cute cerebral infarction,ACI)静脉溶栓患者预后的评估价值。方法选取151例接受静脉溶栓治疗的患者,收集实验室及临床相关资料,统计溶栓前血浆NLR和NIHSS评分。根据发病90d后改良Rankin量表(mRS)评分将患者分为预后不良组(93例)和预后良好组(58例)。采用二元logistic回归分析比较两组临床资料结果,用ROC曲线分析NLR、NIHSS评分与老年患者预后不良的关系及其预测预后不良的价值。结果预后不良组溶栓前NIHSS评分及NLR均高于预后良好组。二元logistic回归分析显示,溶栓前血浆NLR及溶栓前NIHSS评分是急性脑梗死的独立危险因素(P<0.05),溶栓前血浆NLR及NIHSS评分预测急性脑梗死患者静脉溶栓后预后不良的ROC曲线下面积分别是0.720(95%CI 0.639~0.800,P=0.001),0.761(95%CI 0.683~0.840,P=0.001)。结论溶栓前血浆NLR及NIHSS评分可为临床医生初步判断溶栓后预后不良风险、制定合理诊疗方案。

Objective To investigate the prognostic value of neutrophil to lymphocyte ratio(NLR)combined with NIHSS score in elderly patients with acute cerebral infarction(ACI)after intravenous thrombolysis.Methods 151 patients who received intravenous thrombolysis were selected.The laboratory and clinical data were collected,and the NLR and NIHSS scores before thrombolysis were counted.According to the modified Rankin Scale(mRS)score 90 days after onset,the patients were divided into poor prognosis group(93 cases)and good prognosis group(58 cases).Binary logistic regression analysis was used to compare the results of the two groups of clinical data.ROC curve was used to analyze the relationship between NLR,NIHSS score and poor prognosis of elderly patients and the value of predicting poor prognosis.Results NIHSS score and NLR before thrombolysis in the poor prognosis group were higher than those in the good prognosis group.Binary logistic regression analysis showed that plasma NLR before thrombolysis and NIHSS score before thrombolysis were independent risk factors for ACI(P<0.05).The areas under the ROC curve of plasma NLR before thrombolysis and NIHSS score predicting poor prognosis after intravenous thrombolysis in patients with ACI were 0.720(95%CI 0.639~0.800,P=0.001)and 0.761(95%CI 0.683~0.840,P=0.001)respectively.Conclusion Plasma NLR and NIHSS scores before thrombolysis can be used for clinicians to preliminarily judge the risk of poor prognosis after thrombolysis and formulate a reasonable diagnosis and treatment plan.