大动脉粥样硬化型脑梗死中性粒细胞与淋巴细胞比值对静脉溶栓后出血转化的预测价值及神经功能预后的影响

The predictive value of neutrophil to lymphocyte ratio in patients with large atherosclerotic cerebral infarction to hemorrhage transformation after intravenous thrombolysis and the influence on the prognosis of neurological function

目的检测大动脉粥样硬化型脑梗死外周血中性粒细胞与淋巴细胞比值(NLR)对静脉溶栓后出血转化(HT)的预测价值及对神经功能预后的影响。方法选取2013年6月至2021年6月在新乡医学院第三附属医院接受静脉溶栓治疗的大动脉粥样硬化型脑梗死病人147例,根据静脉溶栓后是否发生HT,将病人分为non-HT组(n=105)和HT组(n=42)。比较两组病人的一般临床资料,logistic多因素回归分析影响HT发生的危险因素,受试者工作曲线(ROC)评估NLR、收缩压、心房颤动和脑梗死体积≥10 cm^(3)单独及联合预测HT发生的临床价值。根据NLR预测HT发生的临界值将病人分为NLR高水平组和NLR低水平组,比较两组病人出院后90 d神经功能预后不良率。结果HT组病人年龄、收缩压、中性粒细胞(0.8±0.2)×10^(9)/L、NLR 7.4±0.3、谷草转氨酶(AST)(29.4±6.3)U/L和美国国立卫生研究院卒中量表(NIHSS)评分(6.2±1.7)分高于non-HT组(0.6±0.4)×10^(9)/L、2.1±0.3、(21.6±5.4)U/L和(2.3±0.6)分,淋巴细胞计数(0.1±0.0)×10^(9)/L低于non-HT组(0.3±0.1)×10^(9)/L,差异有统计学意义(P<0.05)。收缩压、心房颤动、NLR和脑梗死体积≥10 cm^(3)为影响HT发生的独立危险因素。NLR预测HT发生的曲线下面积为0.90,大于收缩、心房颤动和脑梗死体积≥10 cm^(3)预测HT发生的曲线下面积(0.72、0.74、0.82),差异有统计学意义(Z=5.33、5.02、4.36,均P<0.05),联合预测HT发生的曲线下面积为0.94,大于NLR、收缩压、心房颤动和脑梗死体积>10 cm^(3)单独预测(Z=3.25、6.33、6.03和5.15,均P<0.05)。NLR高水平组神经功能预后不良率46.5%高于NLR低水平组14.4%,差异有统计学意义(χ^(2)=17.27,P<0.001)。结论NLR水平增加是大动脉粥样硬化型脑梗死静脉溶栓后HT发生的独立危险因素,且对HT具有一定的预测价值,并影响神经功能预后。

Objective To detect the predictive value of neutrophil to lymphocyte ratio(NLR)in peripheral blood of large atherosclerotic cerebral infarction on hemorrhagic transformation(HT)after intravenous thrombolysis and its influence on the prognosis of neurological function.Methods A total of 147 patients with large atherosclerotic cerebral infarction who received intravenous thrombolysis in our hospital from June 2013 to June 2021 were collected.According to whether HT occurred after intravenous thrombolysis,the patients were divided into non-HT group(n=105)and HT group(n=42).The general clinical data of the two groups were compared,logistic multivariate regression was used to analyze the risk factors affecting the occurrence of HT,receiver operating curve(ROC)was used to evaluate the clinical value of NLR in predicting the occurrence of HT.According to the critical value of NLR to predict the occurrence of HT,patients were divided into NLR high-level group and NLR low-level group,and the poor prognosis rate of neurological function of the two groups was compared 90 days after discharge.Results Age,systolic blood pressure,neutrophils(0.8±0.2)×10^(9)/L,NLR(7.4±0.3),aspartate aminotransferase(AST)(29.4±6.3)U/L and National Institutes of Health Stroke Scale(NIHSS)score(6.2±1.7)in HT group were higher than those in non-HT group(0.6±0.4)×10^(9)/L,(2.1±0.3),(21.6±5.4)U/L and(2.3±0.6),while lymphocyte count(0.1±0.0)×10^(9)/L was lower than that of non-HT group(0.3±0.1)×10^(9)/L,and the differences were statistically significant(P<0.05).Systolic blood pressure,atrial fibrillation,NLR and cerebral infarction volume≥10 cm^(3) were independent risk factors that affect the occurrence of HT.The area under the curve predicted by NLR for HT occurrence was 0.90,,which was greater than that predicted by the volume of contraction,atrial fibrillation and cerebral infarction≥10 cm^(3)(0.72,0.74,0.82),the difference was statistically significant(Z=5.33,5.02,4.36,All P<0.05).The combined area under the curve for predicting the occurrence of HT was 0.943,which was greater than that predicted by NLR,systolic blood pressure,atrial fibrillation and cerebral infarction volume≥10 cm^(3) alone(Z=3.25,6.33,6.03 and 5.15,all P<0.05).The poor prognosis rate of neurological function in the high-level NLR group was 46.5%,which was significantly higher than that in the low-level NLR group 14.4%,and the difference was statistically significant(χ^(2)=17.27,P<0.001).Conclusion The increase of NLR level is an independent risk factor for the occurrence of HT after intravenous thrombolysis of large atherosclerotic cerebral infarction and has a certain predictive value for HT,and affects the prognosis of neurological function.