中性粒细胞与淋巴细胞比值对急性前循环大血管闭塞性卒中患者取栓效果的影响

Influence of neutrophil to lymphocyte ratio on thrombectomy effect in stroke patientswith acute anterior circulation large vessel occlusion

目的 探讨中性粒细胞与淋巴细胞比值(NLR)对急性前循环大血管闭塞性卒中患者取栓效果的影响。方法 选取2020年1月至2021年12月在该院进行治疗的113例患者,所有患者均确诊为急性前循环大血管闭塞性卒中并行机械取栓。查阅患者病历资料;测定患者入院时美国国立卫生研究院卒中量表评分、发病至再通时间、手术时间、闭塞时间、侧肢循环等级和入院时实验室各项指标(包括血小板计数、淋巴细胞计数、中性粒细胞计数、血红蛋白、白细胞计数、肌酐、清蛋白、空腹血糖水平等),并计算NLR、血小板与淋巴细胞比值(PLR)。根据患者是否发生首通效应对患者进行分组。分析不同取栓效果患者的各项指标的差异。结果 113例患者分为预后良好组(血管再通)52例和预后不良组(血管未再通)61例。两组患者在侧支循环等级、发病至再通时间、淋巴细胞计数、中性粒细胞计数、NLR、PLR水平方面比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示:高NLR、发病至再通时间长、高PLR为影响患者取栓效果的危险因素(P<0.05);受试者工作特征曲线分析结果显示:NLR、发病至再通时间、PLR这3项指标单独及联合应用时曲线下面积分别为0.767(95%CI 0.531~0.979)、0.707(95%CI 0.445~0.956)、0.717(95%CI 0.473~0.957)、0.861(95%CI 0.744~0.952),联合应用诊断效能更高。结论 术前高NLR水平会影响急性前循环大血管闭塞性卒中患者的取栓效果,并可以作为预测患者预后的有效指标应用于临床。

Objective To explore the influence of neutrophil to lymphocyte ratio on the thrombectomy effect in the stroke patients with acute anterior circulation large vessel occlusion.Methods A total of 113 patients treated in this hospital from January 2020 to December 2021 were selected.All patients were diagnosed as acute anterior circulation large vessel occlusion stroke and underwent the mechanical thrombectomy.The patient′s medical records were consulted.The National Institutes of Health Stroke Scale(NIHSS)score,time from onset to recanalization,operation time,occlusion time,grade of collateral circulation and laboratory parameters on admission were determined(including platelets count,lymphocytes count,neutrophils count,hemoglobin,leukocytes count,creatinine,albumin and fasting blood glucose level),NLR and platelet-to-lymphocyte ratio(PLR)were calculated.The patients were grouped according to whether the first pass effect(FPE)occurred.The differences of various indicators in the patients with different thrombectomy effects were analyzed.Results A total of 113 patients were divided into the good prognosis group(vascular opening,52 cases)and poor prognosis group(vascular non-opening,61 cases).There were statistically significant differences in the grade of collateral circulation,time from onset to recanalization,lymphocytes count,neutrophils count,NLR and PLR levels between the two groups(P<0.05).The Logistic regression analysis results showed that high NLR,time from onset to recanalization and high PLR were the risk factor affecting the thrombectomy effect(P<0.05).The receiver operating characteristic(ROC)curve analysis results showed that in the single use and combined use of NLR,time from onset to recanalization and PLR,the areas under the curve were 0.767(95%CI 0.531-0.979),0.707(95%CI 0.445-0.956),0.717(95%CI 0.473-0.957)and 0.861(95%CI 0.744-0.952)respectively,and the combined use had the higher diagnostic efficiency.Conclusion The preoperative high NLR level could affect the thrombectomy effect in the patients with acute anterior circulation large vessel occlusion stroke and can be used in clinic as an effective indicator for predicting the prognosis of the patients.