全身炎症反应指数预测穿支动脉粥样硬化病患者早期神经功能恶化和转归

Systemic inflammatory response index predicts early neurological deterioration and outcome in patients with branch atheromatous disease

目的探讨全身炎症反应指数(systemic inflammatory response index,SIRI)对穿支动脉粥样硬化病(branch atheromatous disease,BAD)患者早期神经功能恶化(early neurological deterioration,END)和临床转归的预测价值。方法回顾性连续纳入2021年9月至2022年9月在东南大学医学院附属江阴市人民医院神经内科住院的BAD患者,收集患者临床资料并计算SIRI。SIRI计算方法为中性粒细胞计数×单核细胞计数/淋巴细胞计数。END定义为发病1周内患者美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分或运动功能评分增加≥1分。在发病后3个月时使用改良Rankin量表进行转归评价,>2分定义为转归不良。采用多变量logistic回归分析确定SIRI与END以及转归不良的独立相关性,应用受试者工作特征(receiver operating characteristic,ROC)曲线评价SIRI对转归不良的预测价值。结果共纳入125例BAD患者,其中62例(49.6%)发生END,32例(25.6%)转归不良。多变量logistic回归分析结果显示,静脉溶栓[优势比(odds ratio,OR)1.083,95%置信区间(confidence interval,CI)1.082~1.240;P=0.043]和高SIRI(OR 1.465,95%CI 1.150~3.676;P=0.028)是BAD患者发生END的独立危险因素;END(OR 1.130,95%CI 1.032~1.384;P=0.006)、高基线NIHSS评分(OR 1.571,95%CI 1.184~2.101;P=0.003)和高SIRI(OR 2.062,95%CI 1.152~3.672;P=0.01)是BAD患者转归不良的独立危险因素。ROC曲线分析显示,SIRI、基线NIHSS评分以及两者联合预测转归不良的曲线下面积分别为0.66(95%CI 0.54~0.78)、0.70(95%CI 0.58~0.81)和0.83(95%CI 0.74~0.93)。结论高SIRI是BAD患者发生END以及转归不良的独立危险因素。SIRI和基线NIHSS评分对BAD患者转归不良具有一定预测价值,二者联合诊断价值更高。

Objective To investigate the predictive value of systemic inflammatory response index(SIRI)for early neurological deterioration(END)and clinical outcome in patients with branch atherosclerotic disease(BAD).Methods Consecutive patients with BAD admitted to the Department of Neurology,Jiangyin People’s Hospital Affiliated to Southeast University from September 2021 to September 2022 were retrospectively included.The clinical data were collected and SIRI was calculated.The calculation method of SIRI was neutrophil count×monocyte count/lymphocyte count.END was defined as an increase of≥2 in the total score of the National Institutes of Health Stroke Scale(NIHSS)or an increase of≥1 in the motor function score within 1 week of onset.The modified Rankin Scale was used for outcome evaluation at 3 months after onset,with a score>2 were defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent correlation between SIRI and END,as well as poor outcome.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of SIRI for poor outcome.Results A total of 125 patients with BAD were included,of which 62(49.6%)had END and 32(25.6%)had poor outcome.The multivariate logistic regression analysis showed that intravenous thrombolysis(odds ratio[OR]1.083,95%confidence interval[CI]1.082-1.240;P=0.043)and high SIRI(OR 1.465,95%CI 1.150-3.676;P=0.028)were independent risk factors for END in patients with BAD;END(OR 1.130,95%CI 1.032-1.384;P=0.006),high baseline NIHSS score(OR 1.571,95%CI 1.184-2.101;P=0.003)and high SIRI(OR 2.062,95%CI 1.152-3.672;P=0.01)were independent risk factors for poor outcome in patients with BAD.ROC curve analysis showed that the area under the curves for SIRI,baseline NIHSS score,and the both combined prediction of poor outcome were 0.66(95%CI 0.54-0.78),0.70(95%CI 0.58-0.81),and 0.83(95%CI 0.74-0.93),respectively.Conclusions High SIRI is an independent risk factor for END and poor outcome in patients with BAD.The SIRI and baseline NIHSS scores have certain predictive value for poor outcome in patients with BAD,and their combined diagnostic value is higher.