卒中后出血转化与炎症反应相关性研究

Correlation between Bleeding Transformation and Inflammation Reactions after Stroke

目的探讨中性粒细胞/淋巴细胞(neutrophil/lymphocyte,NLR)、C反应蛋白/白蛋白(C reactive protein/albumin,CAR)、血小板/淋巴细胞(platelet/lymphocyte,PLR)与卒中后出血转化(hemorrhagic transformation,HT)的关系。方法选择符合HT诊断标准的38例(血管介入组18例,静脉溶栓组20例)患者为HT组,另外选择卒中后无出血的53例患者作为对照组(非HT组),检测两组患者的NLR、PLR、CAR水平。结果HT组患者的高血压、房颤、大面积脑梗死、NHISS评分、NLR、PLR、CAR水平均高于非HT组(P<0.05)。通过多因素Logistic回归结果显示,调整其他影响因素后,房颤(OR=13.387,95%CI:1.291~138.829)、国立卫生研究院卒中量表(National institutes of health stroke scale,NHISS)评分(OR=1.268,95%CI:1.046~1.537)、CAR(OR=628.341,95%CI:2.973~132780.890)、NLR(OR=1.618,95%CI:0.892~2.933)和PLR(OR=1.058,95%CI:1.009~1.109)均为HT患者的危险因素,并且预测值与真实值之间无明显差异;Logistic回归模型拟合度较好(hosmer-lemeshow P=0.229)。结论高血压病、大面积脑梗死、NLR是HT的危险因素;NHISS评分、房颤、CAR、PLR是发生HT的独立危险因素;高水平NLR、CAR、PLR急性脑梗死患者发生HT风险大,三者联合对HT预测效果更好。

[WTHZ]Objective[WT][KG1]To investigate the relationship between neutrophil/lymphocyte ratio(NLR),C-reactive protein/albumin ratio(CAR),platelet/lymphocyte ratio(PLR)and hemorrhagic transformation(HT)after stroke.[WTHZ]Method[WT][KG1]38 patients(18 cases of vascular intervention group and 20 cases of venous thrombolysis group)who met HT diagnostic standard were HT group,and 53 patients who had no bleeding after the stroke were used as the control group(non-HT group)to detect NLR,PLR,CAR level of patients.[WTHZ]Results[WT][KG1]The proportion of hypertension,atrial fibrillation,large cerebral infarction,NHISS score,NLR,PLR and CAR levels in HT group were higher than those in non-HT group(P<0.05).Through multi-factor Logistic regression results,atrial fibrillation(OR=13.387,95%CI:1.291~138.829),NHISS score(OR=1.268,95%CI:1.046~1.537),CAR(OR=628.341,95%CI:2.973~132780.890),NLR(OR=1.618,95%CI:0.892~2.933),PLR(OR=1.058,95%CI:1.009~1.109)are risk factors for HT patients after adjusting other factors,and there is no significant difference between the predicted value and the real value,and the Logistic regression model fits well(hosmer-lemeshow P=0.229).[WTHZ]Conclusion[WT][KG1]Hypertension,massive cerebral infarction and NLR are the risk factors of HT;NHISS score,atrial fibrillation,CAR and PLR are independent risk factors for HT;Patients with acute cerebral infarction with high levels of NLR,CAR and PLR have a higher risk of developing HT,and the combination of the three has a better predictive effect on HT.