中性粒细胞/淋巴细胞比值对不伴感染症状的急性缺血性卒中患者静脉溶栓预后的预测价值

Predictive value of neutrophil-to-lymphocyte ratio for prognosis of intravenous thrombolysis in treatment of acute ischemic stroke in patients without symptoms of infection

目的 探讨中性粒细胞/淋巴细胞比值(NLR)对不伴感染症状的急性缺血性卒中(AIS)患者静脉溶栓后3个月预后的预测价值。方法 选择2016年7月至2021年12月郑州人民医院神经内科收治的200例不伴感染症状AIS患者为研究对象,患者应用注射用阿替普酶静脉溶栓;于静脉溶栓后3个月行改良Rankin Scale(mRS)评分,根据mRS评分将患者分为预后良好组(n=160)和预后不良组(n=40)。比较2组患者的年龄、性别、吸烟、既往史(包括高血压、卒中、糖尿病、心房颤动、冠状动脉性心脏病)及入院时NLR、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)和美国国立卫生研究院卒中量表(NIHSS)评分。应用多因素logistic回归分析不伴感染症状AIS患者静脉溶栓后3个月预后的影响因素,受试者操作特征(ROC)曲线评估NLR对不伴感染症状AIS患者静脉溶栓后3个月预后的预测价值。结果 预后不良组患者的年龄、入院时NIHSS评分、NLR显著高于预后良好组(P<0.05);预后良好组与预后不良组患者的性别分布、吸烟比例、有高血压史比例、有卒中史比例、有糖尿病史比例、有心房颤动史比例、有冠状动脉性心脏病史比例及总胆固醇、三酰甘油、LDL-C水平比较差异无统计学意义(P>0.05)。入院时年龄[比值比(OR)=1.044,95%置信区间(CI):1.009~1.082,P<0.05]、NIHSS评分(OR=6.966,95%CI:2.801~17.327,P<0.001)和NLR(OR=1.165,95%CI:1.018~1.333,P<0.001)是不伴感染症状AIS患者静脉溶栓后3个月不良预后的独立影响因素。NLR评估不伴感染症状AIS患者静脉溶栓不良预后的ROC曲线下面积为0.636,最佳界值为3.39,敏感度、特异度分别为57.5%、75.6%。结论 入院时NLR是不伴感染症状AIS患者静脉溶栓后3个月不良预后的独立影响因素,可作为评估静脉溶栓后3个月不良预后的预测指标。

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR) for the prognosis of acute ischemic stroke(AIS) patients without infection symptoms at three months after intravenous thrombolysis.Methods A total of 200 AIS patients without infection symptoms admitted to the Department of Neurology, Zhengzhou People′s Hospital from July 2016 to December 2021 were selected as the study subjects.All patients were treated with intravenous thrombolysis with ateplase;modified Rankin scale(mRS) score was performed at three months after intravenous thrombolysis.The patients were divided into good prognosis group(n=160) and poor prognosis group(n=40) according to mRS score.The age, gender, smoking, past history(including hypertension, stroke, diabetes, atrial fibrillation, coronary heart disease) and NLR,triacylglycerol, low-density lipoprotein cholesterol(LDL-C) and National Institute of Health stroke scale(NIHSS) score at admission were compared between the two groups.The influencing factors of the prognosis of AIS patients without infection symptoms at three months after intravenous thrombolysis was analyzed by multivariate logistic regression, and the predictive value of NLR for prognosis of AIS patients without infection symptoms at three months after intravenous thrombolysis was evaluated by the receiver operating characteristic(ROC) curve.Results The age, NIHSS score and NLR of patients in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).There were no significant differences in gender distribution, smoking ratio, history of hypertension ratio, history of stroke ratio, history of diabetes ratio, history of atrial fibrillation ratio, history of coronary heart disease ratio and the levels of NLR,triacylglycerol, LDL-C of patients between the good prognosis group and poor prognosis group(P>0.05).The age [odds ratio(OR)=1.044,95% confidence interval(CI):1.009-1.082,P<0.05],NIHSS score(OR=6.966,95%CI:2.801-17.327,P<0.001) and NLR(OR=1.165,95%CI:1.018-1.333,P<0.001) of patients at admission were the independent predictors for poor prognosis of AIS patients without infection symptoms at three months after intravenous thrombolysis.The ROC area under curve of NLR in evaluating the poor prognosis of AIS patients without infection symptoms at three months after intravenous thrombolysis was 0.636,the optimal cut-off value was 3.39,the sensitivity and specificity were 57.5% and 75.6%,respectively.Conclusion NLR at admission was an independent factor for poor prognosis of AIS patients without infection symptoms at three months after intravenous thrombolysis, and which can be used as a predictor in evaluating poor prognosis of the patients at three months after intravenous thrombolysis.