急性前循环大血管闭塞机械取栓术后血管复流程度与中性粒细胞和淋巴细胞比值的关系

The relationship between the degree of reperfusion after mechanical thrombectomy and the neutrophilto-lymphocyte ratio in patients with acute anterior circulation large vessel occlusion

目的 探讨前循环大血管闭塞患者接受机械取栓术后闭塞血管复流程度与治疗前外周静脉血中性粒细胞和淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)的关系。方法 回顾性分析2016年6月至2022年3月苏州大学附属第一医院接受机械取栓治疗的前循环大血管闭塞性急性缺血性脑卒中(acute ischemic stroke,AIS)患者的临床资料。根据改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,m TICI)评估术后闭塞血管的复流程度,将所有成功复流患者分为部分复流组(mTICI=2b级)及完全复流组(m TICI=3级)。比较两组患者的基本临床资料、疾病特征、介入治疗及预后的相关数据,多因素logistic分析术后复流程度的影响因素。结果 共纳入患者214例,其中部分复流65例,完全复流149例。单因素分析结果显示,两组患者的术前NLR、闭塞血管位置、血栓负荷量、穿刺至再通时间、取栓次数、术后90 d预后良好率差异均有统计学意义(均P<0.05)。与部分复流患者相比,完全复流患者的NLR更低、闭塞血管更多位于大脑中动脉、血栓负荷量更低、手术时间更短、取栓次数更少以及临床预后更好。多因素logistic回归分析显示,NLR与低血栓负荷是前循环AIS患者术后完全复流的独立影响因素。结论 机械取栓术前低NLR和低血栓负荷量的前循环AIS患者,术后更容易达到完全复流。

Objective To investigate the relationship between the reperfusion degree of the occlusive vessel and the preoperative neutrophil-to-lymphocyte ratio(NLR) of peripheral venous blood in patients with acute anterior circulation large vessel occlusion after mechanical thrombectomy(MT).Methods The clinical data of the patients with anterior circulation acute ischemic stroke(AIS),who received MT at the First Affiliated Hospital of Soochow University of China between June 2016 and March 2022,were retrospectively analyzed.Modified thrombolysis in cerebral infarction(mTICI) was used to evaluate the degree of reperfusion after MT.The patients having successful reperfusion after MT were divided into partial reperfusion group(mTICI of gradeⅡb) and complete reperfusion group(mTICI of grade Ⅲ).The basic clinical data,disease characteristics,interventional therapy,and prognosis were compared between the two groups.Univariate analysis and multivariate logistic analysis were used to analyze the factors affecting the degree of reperfusion after MT.Results A total of 214 patients were enrolled in this study,including 65 patients in partial reperfusion group and 149 patients in complete reperfusion group.Univariate analysis showed that the differences in preoperative NLR value,location of the occluded vessels,clot burden,time from puncture to recanalization,times of thrombus removal procedure,and the 90-day good prognosis rate between the two groups were statistically significant(all P<0.05).Compared with partial reperfusion group,in complete reperfusion group the NLR value was lower,more occluded vessels were located in the middle cerebral artery,the clot burden was lower,the time spent for operation was shorter,the thrombus removal times was fewer,and the clinical prognosis was better.Multivariate logistic regression analysis revealed that NLR value and low clot burden were the independent influencing factors for complete reperfusion in the patients with anterior circulation AIS after MT.Conclusion Patients with anterior circulation AIS,who have lower NLR value and lower clot burden,are more likely to achieve complete reperfusion after MT.