中性粒细胞与淋巴细胞比值与急性脑梗死早期神经恶化和功能预后的相关性研究

The correlation between the ratio of neutrophils to lymphocytes and early neurological deterioration and functional prognosis in acute cerebral infarction

目的探讨中性粒细胞与淋巴细胞比值(NLR)与急性脑梗死早期神经恶化(END)和不良功能预后的相关性。方法前瞻性连续收集2017年10月至2019年6月本院神经内科住院诊疗的急性脑梗死患者204例,分为END组(n=58)和非END组(n=146),对两组患者临床资料进行对比分析。根据出院后3个月改良Rankin(mRS)量表评分,以3~6分划分为不良预后组(n=60),mRS评分≤2分划分为良好预后组(n=144),对两组患者临床资料进行对比分析,采用Logistic多因素回归分析影响END和不良预后的因素,采用患者工作特征曲线(ROC)分析NLR对END或不良预后的诊断价值。结果多变量Logistic分析显示,在校正其他混杂因素后,中性粒细胞计数(优势比7.261,95%CI=1.818~28.994;P=0.005)、淋巴细胞计数(优势比0.034,95%CI=0.002~0.502;P=0.014)、纤维蛋白原(优势比2.127,95%CI=1.046~4.326;P=0.037)为END发生的独立预测因素。NLR(优势比2.829,95%CI=1.244~6.432;P=0.013)、入院NIHSS评分(优势比1.502,95%CI=1.319~1.709;P<0.001)为不良预后的独立预测因素。ROC分析显示入院基线NLR值预测不良预后的曲线下面积为0.706(95%CI=0.629~0.783,P<0.001),当截断值为2.01时,预测不良预后的敏感性和特异性分别为75%和59%。结论入院后NLR升高不是END发生的独立危险因素,是不良预后的独立危险因素,监测NLR对早期识别和预测不良预后有一定的价值。

Objective To investigate the correlation between neutrophil to lymphocyte ratio and the early neurological deterioration and poor outcome of acute cerebral infarction.Methods 204 patients with acute cerebral infarction who were hospitalized in the Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai from October 2017 to June 2019 were prospectively collected.Patients were divided into the early neurological deterioration group(END group=58)and the non-early neurological deterioration group(non-END group=146).The clinical data of the two groups of patients were compared and analyzed.According to modified Rankin Scale(mRS)score 3 months after discharge,the patients were divided into the poor outcome group by 3~6(n=60),and the patients with mRS score≤2 were divided into the good outcome group(n=144).The clinical data of the two groups of patients were compared and analyzed.Multivariate Logistic regression analysis was used to determine the independent risk factors for END and poor outcome.ROC curve was used to analyze the diagnostic value of NLR in end or poor prognosis.Results A total of 204 patients with acute cerebral infarction were enrolled,including 132 males(64.7%)and aged 65.1±12.4 years,58 patients(28.4%)in the END group and 146 patients(71.6%)in the non-END group,60 patients(29.4%)in the poor outcome group and 144 patients(70.6%)in the good outcome group.Multivariate Logistic regression analysis showed that after adjusting for other confounding factors,neutrophils count(odds ratio 7.261,95%confidence interval 1.818 to 28.994;P=0.005),lymphocyte count(odds ratio 0.034,95%confidence interval 0.002~0.502;P=0.014),fibrinogen(odds ratio 2.127,95%confidence interval 1.046 to 4.326;P=0.037)was an independent predictors of END.NLR(odds ratio 2.829,95%confidence interval 1.244 to 6.432;P=0.013),NIHSS score at admission(odds ratio 1.502,95%confidence interval 1.319 to 1.709;P<0.001)were independent predictors of poor outcome.ROC analysis showed that the area under the curve of admission baseline NLR value in predicting adverse prognosis was 0.706(95%confidence interval 0.629~0.783,P<0.001).When the cutoff value was 2.01,the sensitivity and specificity for predicting adverse prognosis were 75%and 59%.Conclusion The elevated NLR after admission is not an independent risk factor for END,monitoring the ratio of neutrophils to lymphocytes has a certain value in early recognition and prediction of poor prognosis.