外周血血小板/淋巴细胞比值、纤维蛋白原/白蛋白比值与缺血性卒中静脉溶栓后出血转化的相关性

Correlation analysis of peripheral blood blood platelet-to-lymphocyte ratio,fibrinogen-to-albu⁃min ratio and hemorrhage transformation after intravenous thrombolysis for ischemic stroke

目的探讨缺血性卒中(AIS)病人静脉溶栓后外周血血小板/淋巴细胞比值(PLR)、纤维蛋白原/白蛋白比值(FAR)与出血转化(HT)的关系。方法选取2019年3月至2020年5月在青岛大学附属医院接受静脉溶栓治疗的133例AIS病人作为研究组,根据AIS病人静脉溶栓后是否发生HT,分为HT组20例,非HT组113例;分析影响AIS病人静脉溶栓后HT发生的因素;检测并比较各组PLR、FAR大小;使用ROC曲线分析PLR、FAR对AIS病人静脉溶栓后HT发生的预测价值;采用多因素lo-gistic回归分析AIS病人静脉溶栓后HT发生的危险因素。结果HT组美国国立卫生研究院卒中量表(NIHSS)评分[(16.20±4.35)分比(10.09±3.15)分]、改良Rankin量表(mRS)评分[(4.55±0.89)分比(1.33±0.47)分]、空腹血糖(FPG)[(8.91±1.21)mmol/L比(7.43±1.10)mmol/L]、纤维蛋白原(FBI)[(3.56±0.14)g/L比(3.31±0.11)g/L]、中性粒细胞计数[(6.92±1.73)×10^(9)/L比(4.55±1.56)×10^(9)/L]、血小板(PLT)[(210.91±60.15)×10^(9)/L比(180.79±58.71)×10^(9)/L]、发病至溶栓时间显著高于非HT组(P<0.05),HT组病人淋巴细胞(LYM)、白蛋白(ALB)低于非HT组(P<0.05);与非HT组比较,HT组病人外周血PLR、FAR显著升高(P<0.05);ROC曲线分析显示,PLR、FAR联合预测AIS病人静脉溶栓后HT发生的曲线下面积(AUC)为0.92(0.87,0.96),明显高于二者单独预测的AUC(P<0.05),灵敏度为97.9%,特异度为85.2%;多因素logistic回归分析表明,NIHSS评分、mRS评分、PLR、FAR是AIS病人静脉溶栓后HT发生的独立危险因素(P<0.05)。结论PLR、FAR与AIS病人静脉溶栓后HT的发生有关,可作为评估AIS病人静脉溶栓后HT发生的辅助指标。

Objective To investigate the relationship between peripheral blood platelet-to-lymphocyte ratio(PLR),fibrinogen-to-albumin ratio(FAR)and hemorrhagic transformation(HT)in patients with ischemic stroke(AIS)after intravenous thrombolysis.Methods A total of 133 AIS patients who received intravenous thrombolysis in the Affiliated Hospital of Qingdao University from March 2019 to May 2020 were selected as the study group.According to whether AIS patients had HT after intravenous thrombolysis,they were assigned into HT group(20 cases)and non-HT group(113 cases);the factors affecting the occurrence of HT after intravenous thrombolysis in AIS patients were analyzed;the PLR and FAR in each group were detected and compared;the predictive value of PLR and FAR on the occurrence of HT after intravenous thrombolysis in AIS patients was analyzed with ROC curve;multivariate logistic regression was used to analyze the risk factors of HT after intravenous thrombolysis in patients with AIS.Results National institute of health stroke scale(NIHSS)score[(16.20±4.35)vs.(10.09±3.15)],modified Rankin scale(mRS)score[(4.55±0.89)vs.(1.33±0.47)],fasting blood glucose(FPG)[(8.91±1.21)mmol/L vs.(7.43±1.10)mmol/L],fibrinogen(FBI)[(3.56±0.14)g/L vs.(3.31±0.11)g/L],neutrophil count[(6.92±1.73)×10^(9)/L vs.(4.55±1.56)×10^(9)/L],platelet(PLT)[(210.91±60.15)×10^(9)/L vs.(180.79±58.71)×10^(9)/L],and time from onset to thrombolysis in the HT group were significantly higher than those in the non-HT group(P<0.05);lymphocytes count(LYM)and albumin(ALB)in the HT group were lower than those in the non-HT group(P<0.05);compared with the non-HT group,the peripheral blood PLR and FAR of the HT group were significantly higher(P<0.05);ROC curve analysis showed that the area under the cure(AUC)of PLR and FAR in predicting HT after intravenous thrombolysis in patients with AIS was 0.92(0.87,0.96),which was significantly higher than that predicted by them alone(P<0.05),the sensitivity was 97.9%and the specificity was 85.2%;multivariate logistic regression analysis showed that NIHSS score,mRS score,PLR and FAR were independent risk factors for HT after intravenous thrombolysis in AIS patients(P<0.05).Conclusion PLR and FAR are related to the occurrence of HT after intravenous thrombolysis in AIS patients,and they can be used as auxiliary indicators for the occurrence of HT after intravenous thrombolysis in AIS patients.