血浆脂蛋白磷脂酶A2与中性粒细胞、淋巴细胞比值对急性缺血性卒中患者溶栓后早期神经功能恶化的影响

Effects of plasma lipoprotein phospholipase A2 and neutrophil-to-lymphocyte ratio on early neurological deterioration after thrombolysis in patients with acute ischemic stroke

目的分析血浆脂蛋白磷脂酶A2(Lp-PLA2)与中性粒细胞与淋巴细胞比值(NLR)对急性缺血性脑卒中(AIS)患者溶栓后早期神经功能恶化(END)的影响。方法收集2020年1月至2021年12月在沈阳市第四人民医院神经内科接受溶栓治疗的AIS患者114例,根据溶栓后24h内NIHSS评分变化将患者分为END组(NIHSS评分增加≥4分,n=40例)和神经功能改善(ENI,NIHSS评分减少≥4分或神经功能缺损完全消退,n=74例)。比较两组间的一般临床资料包括人口特征、危险因素、用药史、临床评估指标、卒中类型、病变部位、实验室检测指标和Lp-PLA2水平。采用单因素和多因素回归分析影响END的危险因素,并根据受试者工作曲线(ROC)评估NLR、Lp-PLA2预测END发生的临床价值。比较NLR低水平组、高水平组及Lp-PLA2低水平组、Lp-PLA2高水平组间END的发生率。结果END组与ENI组相比,患者年龄较大[(67.2±5.2)岁vs(649±6.3)岁]、糖尿病患者比例高[(30.0%)vs(13.5%)]、NIHSS评分高[11(5,17)分vs7(4,14)分]、HT比例高[(20.0%)vs(4.1%)]、OTT时间长[170.0(120.0,240.0)min vs 125.0(90.0,180.0)min]、PAO[(7.1±1.0)mg·L^(-1)vs(4.3±0.5)mg·L^(-1)]、NLR[6.3(4.2,8.4)vs(0.924(0.847~0.968))]和Lp-PLA2水平高[(324.1±42.1)pg·mL^(-1)vs(214.6±32.6)pg·mL^(-1)],组间比较有统计学差异(P<0.05)。年龄[(OR 95%CI)=0.925(0.874~0.986),P=0.032]、HT[OR(95%CI)=0.325(0.105~0.482),P=0.012]、OTT[OR(95%CI)=0.263(0.008~0.521),P=0.032]、PAO[OR(95%CI)=0.018(0.007~0.503),P=0.011]、NLR[OR(95%CI)=0.858(0.841~0.997),P=0.013]和Lp-PLA2[OR(95%CI)=1.426(1.106~2.631),P=0.041]为影响END危险因素。NLR预测END的曲线下面积为0.859(95%CI:0.836~0.912)高于LpPLA20.746(95%CI:0.701~0.794),Z=4.201,P=0.015。NLR高水平组END发生率66.7%高于NLR低水平组10.6%,Lp-PLA2高水平组END发生率44.1%高于Lp-PLA2低水平组25.5%,组间比较差异均有统计学差异(χ^(2)=38.804,P<0.001;χ^(2)=4.330,P=0.037)。结论Lp-PLA2和NLP在AIS溶栓后END患者中的水平增加,且NLR对END的预测价值高于Lp-PLA2,具有较高的临床价值。

Objective To analyze the effect of plasma lipoprotein phospholipase A2(Lp-PLA2)and neutrophil-to-lymphocyte ratio(NLR)on early neurological deterioration(END)in patients with acute ischemic stroke(AIS)after thrombolysis.Methods A total of 114 patients with AIS who received thrombolysis in our hospital from January 2020 to December 2021 were collected.According to the changes of NIHSS score within 24 hours after thrombolysis,the patients were divided into END group(NIHSS score increased by≥4 points,n=40 cases)and neurological improvement(ENI,NIHSS score reduction of≥4 points or complete regression of neurological deficits,n=74 cases).The general clinical data between the two groups included demographic characteristics,vascular risk factors,medication history,clinical assessment indicators,stroke type,lesion location,laboratory test indicators and Lp-PLA2 levels were compared.Univariate and multivariate regression analysis were used to analyze the risk factors affecting END,and the clinical value of NLR and Lp-PLA2 in predicting the occurrence of END was evaluated according to receiver operating curve(ROC).The incidence of END was compared between the NLR low-level group,high-level group,and Lp-PLA2 low-level group and Lp-PLA2 high-level group.Results Compared with the ENI group,the patients in the END group were older[(67.2±5.2)vs(64.9±6.3)years],had a higher proportion of diabetic patients[(30.0%)vs(13.5%)],and had a higher NIHSS score[11(5,17)points vs 7(4,14)points],high HT ratio[(20.0%)vs(4.1%)],long OTT time[170.0(120.0,240.0)min vs 125.0(90.0,180.0)min],PAO[(7.1±1.0)mg·L^(-1)vs(4.3±0.5)mg·L^(-1)],NLR[6.3(4.2,8.4)vs(0.924(0.847~0.968))]and the level of Lp-PLA2[(324.1±42.1)pg·mL^(-1)vs(214.6±32.6)pg·mL^(-1)]were high,and there were a statistical difference between the groups(P<0.05).Age[OR(95%CI)=0.925(0.874-0.986),P=0.032],HT[OR(95%CI)=0.325(0.105-0.482),P=0.012],OTT[OR(95%CI)=0.263(0.008-0.521),P=0.032],PAO[OR(95%CI)=0.018(0.007-0.503),P=0.011],NLR[OR(95%CI)=0.858(0.841-0.997),P=0.013]and Lp-PLA2[OR(95%CI)=1.426(1.106-2.631),P=0.041]were risk factors for END.The area under the curve of NLR for predicting END was 0.859(95%CI:0.836-0.912)higher than that of Lp-PLA20.746(95%CI:0.701-0.794),Z=4.201,P=0.015.The incidence of END in the high-level NLR group was 66.7%higher than that in the low-level NLR group(10.6%),and the incidence of END in the high-level Lp-PLA2 group was 44.1%higher than that in the low-level Lp-PLA2 group(25.5%)(χ^(2)=38.804,P<0.001;χ^(2)=4.330,P=0.037).Conclusion The levels of Lp-PLA2 and NLR increase in END patients after AIS thrombolysis,and the predictive value of NLR for END is higher than that of Lp-PLA2,which has a higher clinical value.