预后营养指数对老年急性缺血性脑卒中患者静脉溶栓后短期功能预后的预测价值

Prognostic value of prognostic nutritional index for short-term functional outcome of elderly patients with AIS after intravenous thrombolysis

目的评估预后营养指数(PNI)对阿替普酶静脉溶栓治疗的老年急性缺血性脑卒中(AIS)患者短期功能预后的预测价值。方法回顾性收集2019年8月至2022年2月徐州医科大学附属医院急诊绿色通道收治的阿替普酶静脉溶栓治疗的老年AIS患者312例,分析患者血液学资料,计算PNI,评估营养状况。随访3个月,采用改良的Rankin量表(mRS)评分分为预后不良组100例(mRS评分>2分),预后良好组212例(mRS评分≤2分)。又根据PNI最佳截断值分为高PNI组144例(PNI≥48.95)和低PNI组168例(PNI<48.95)。采用logistic回归分析PNI与短期功能预后的关系。结果预后不良组PNI明显低于预后良好组[44.7(41.6,47.6)vs 49.9(45.8,53.9),P<0.01]。低PNI组3个月mRS评分明显高于高PNI组[3.0(1.3,4.0)分vs 1.0(1.0,2.0)分,P<0.01]。logistic回归分析显示,美国国立卫生研究院卒中量表评分、TOAST病因分型(大动脉粥样硬化型)、出血转化、体质量指数、低PNI与短期功能预后不良独立相关(P<0.01)。以高PNI组为参照,低PNI组与3个月功能预后不良显著相关(OR=4.686,95%CI:2.221~9.885,P=0.001)。Spearman相关性分析显示,PNI与3个月mRS评分呈负相关(r=-0.474,P<0.01)。ROC曲线分析显示,PNI预测老年AIS患者预后的曲线下面积为0.762(95%CI:0.707~0.817)。结论PNI是一个有前景、可以直接用于筛查老年AIS患者免疫营养状况的指标。

Objective To evaluate the predictive value of prognostic nutritional index(PNI)for short-term functional prognosis in elderly patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods A total of 312 elderly AIS patients admitted by emergency green channel and treated with alteplase in our hospital from August 2019 to February 2022 were recr-uited in this study.Their hematological data were collected,and PNI was calculated to assess their nutritional status.In 3 months after follow-up,mRS was used to assess the patients,and then they were divided into poor prognosis group(mRS score>2,n=100)and good prognosis group(mRS score≤2,n=212).Based on the best cut-off value of PNI,144 patients were assigned into high PNI group(PNI≥48.95)and 168 patients into low PNI group(PNI<48.95).Logistic regression was used to analyze the relationship between PNI and short-term functional prognosis.Results PNI was significantly lower in the poor prognosis group than the good prognosis group[44.7(41.6,47.6)vs 49.9(45.8,53.9),P<0.01].The low PNI group had significantly higher mRS score at 3 months than the high PNI group[3.0(1.3,4.0)vs 1.0(1.0,2.0),P<0.01].Logistic regression analysis showed that the NIHSS score at admission,TOAST etiology classification(large artery atherosclerosis),hemorrhagic transformation,body mass index,and low PNI were independently associated with poor short-term functional prognosis(P<0.01).With reference to the high PNI group,low PNI was significantly associated with poor functional prognosis at 3 months(OR=4.686,95%CI:2.221-9.885,P=0.001).Spearman correlation analysis indicated that PNI was negatively correlated with 3-month mRS score(r=-0.474,P<0.01).ROC curve analysis displayed that the area under the curve of PNI predicting the prognosis of elderly AIS patients was 0.762(95%CI:0.707-0.817).Conclusion PNI is a promising indicator that can be directly used to screen the immune and nutritional status of elderly AIS patients.