多种炎症标志物与急性缺血性脑卒中患者血管内治疗近中期预后的相关性

Correlation between Multiple Inflammatory Markers and Short-to Medium-term Prognosis after Endovascular Treatment for Acute Ischemic Stroke Patients

目的 探究多种炎症标志物在急性缺血性脑卒中患者血管内治疗后近中期预后中的预测作用。方法 选取2020年1月—2022年12月哈尔滨医科大学附属第一医院神经内科接受血管内治疗的376例急性缺血性脑卒中患者进行回顾性分析。根据术后90 d的改良Rankin量表(mRS)评分,将其分为预后不良组184例(mRS≤2分)和预后良好组192例(mRS>2分)。通过电子病历系统收集所有患者的临床资料,采用多因素logistic回归模型筛选老年急性缺血性脑卒中患者预后不良的危险因素,采用ROC曲线评估术前各炎症指标对其预后不良的预测价值。结果 单因素分析显示,预后不良组年龄>75岁的比例和伴糖尿病比例均高于预后良好组(P<0.05),红细胞分布宽度、中性粒细胞与淋巴细胞比值(NLR)、系统免疫炎症指数(SII)、纤维蛋白原与白蛋白比值(FAR)及C反应蛋白均大于预后良好组(P<0.05),术后改良脑梗死溶栓(mTICI)分级≥2b级的比例低于预后良好组(P<0.05)。多因素logistic回归模型分析显示,年龄>75岁、NLR、SII、FAR是老年急性缺血性脑卒中患者近中期预后不良的独立危险因素(P<0.05),mTICI分级≥2b级是其保护因素(P<0.05)。ROC曲线显示,SII预测预后不良的曲线下面积最大,其次为NLR、FAR。结论 术前NLR、SII、FAR均是老年急性缺血性脑卒中患者血管内治疗后近中期预后不良的危险因素,这些指标可预测预后不良的风险,尤以SII的预测价值最高。

Objective To investigate the predictive role of multiple inflammatory markers in the short-to medium-term prognosis of acute ischemic stroke patients after endovascular treatment.Methods 376 acute ischemic stroke patients treated with endovascular treatment in the Department of Neurology of the First Hospital of Harbin Medical University from January 2020 to December 2022 were retrospectively included.According to the modified Rankin scale(mRS)score at 90 d postoperatively,they were divided into 184 cases in the poor prognosis group(mRS≤2 scores)and 192 cases in the good prognosis group(mRS>2 scores).The clinical data of all patients was collected through the electronic medical record system,the risk factors for poor prognosis in elderly acute ischemic stroke patients were screened by multivariate logistic regression,and the ROC curve was used to assess the clinical value of each preoperative inflammatory index in predicting poor prognosis in elderly acute ischemic stroke patients.Results Univariate analysis showed that compared with the good prognosis group,the age>75 years,the proportion of diabetes mellitus,and the erythrocyte pressure volume,neutrophil to lymphocyte ratio(NLR),systemic immune-inflammation index(SII),fibrinogen to albumin ratio(FAR),and CRP were elevated,and the proportion of≥2b grade of modified thrombolysis in cerebral infarction(mTICI)grade was reduced at the postoperative period in the poor prognosis group(P<0.05).The results of the multivariate logistic regression showed that,age>75 years,NLR,SII,FAR were independent risk factors for poor prognosis in the near-to mid-term in elderly acute ischemic stroke patients(P<0.05),and mTICI grade≥2b was a protective factor(P<0.05).The ROC curves showed that SII predicted poor prognosis in elderly acute ischemic stroke patients with the highest AUC,followed by the NLR,and FAR had the lowest AUC on the ROC curve.Conclusion Preoperative NLR,SII,and FAR are all risk factors for and predictive of poor prognosis in the near to midterm period after endovascular treatment in elderly patients with acute ischemic stroke,with SII having the highest predictive value.