NLR在急性缺血性脑卒中患者早期神经功能损伤、预后及复发风险评估中的价值

Neutrophil-to-lymphocyte ratio in the assessment of early neurological impairment, prognosis and risk of recurrence in pa-tients with acute ischemic stroke

目的探讨中性粒细胞/淋巴细胞比值(NLR)在急性缺血性脑卒中(AIS)患者早期神经功能损伤、预后及复发风险评估中的价值。方法选取2022年4月至2023年10月宁波市医疗中心李惠利医院收治的经临床和影像学检查证实为AIS的患者236例为研究对象,根据TOAST分型标准分为大动脉粥样硬化型151例、心源性栓塞型30例、小动脉闭塞型55例。比较不同TOAST分型AIS患者性别、年龄、高血压史、糖尿病史、吸烟史、饮酒史、入院时美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)、Essen卒中风险评分量表(ESRS)评分、中性粒细胞绝对值(N)、NLR、红细胞分布宽度(RDW)、超敏C反应蛋白(hs-CRP)、D-二聚体、同型半胱氨酸(Hcy)、IL-6、IL-10的差异。根据入院时NIHSS、mRS、ESRS评分结果,采用单因素及多因素二元logistic回归分析影响AIS患者神经功能损伤程度、预后状况及复发风险的因素。ROC曲线评估实验室指标判断AIS患者神经功能损伤程度、预后状况及复发风险的效能。采用Spearman秩相关分析AIS患者NLR与NIHSS评分、mRS评分、ESRS评分的相关性。结果不同TOAST分型AIS患者年龄、NIHSS评分、mRS评分、ESRS评分、N、NLR、RDW、hs-CRP、D-二聚体、Hcy、IL-6、IL-10水平比较,差异均有统计学意义(均P<0.05)。多因素分析显示,NLR是AIS患者神经功能损伤程度的独立影响因素(P<0.05)。NLR、hs-CRP、D-二聚体是AIS患者神经功能预后状况的独立影响因素(均P<0.05)。NLR、D-二聚体是AIS患者复发风险的独立影响因素(均P<0.05)。NLR判断AIS患者神经功能损伤程度的最佳截断值为2.52,灵敏度为0.734,特异度为0.528,AUC为0.670。NLR联合hs-CRP、D-二聚体判断AIS患者神经功能预后状况的最佳截断值为0.40,灵敏度为0.718,特异度为0.730,AUC为0.781。NLR联合D-二聚体判断AIS患者复发风险的最佳截断值为0.42,灵敏度为0.736,特异度为0.661,AUC为0.736。Spearman秩相关分析显示,NLR与NIHSS评分、mRS评分、ESRS评分均呈正相关(rs=0.291、0.358、0.277,均P<0.001)。结论NLR在AIS患者早期神经功能损伤、预后及复发风险评估中具有一定临床价值,NLR联合hs-CRP、D-二聚体等指标可有效提高AIS患者神经功能预后评估的效能。

Objective To investigate the value of neutrophil-to-lymphocyte ratio(NLR)in the assessment of early neurological impairment,prognosis and risk of recurrence in patients with acute ischemic stroke(AIS).Methods A total of 236 patients with AIS admitted to Ningbo Medical Center Li Huili Hospital from April 2022 to October 2023 were enrolled.According to the TOAST criteria,patients were classified as large-artery atherosclerosis type(n=151),cardioembolism type(n=30)and small-artery occlusion type(n=55).Gender,age,history of hypertension,diabetes,smoking,drinking,National Institutes of Health stroke scale(NIHSS)score,modified Rankin scale(mRS)score,Essen stroke risk scale(ESRS)score,neutrophil(N),NLR,red cell distribution width(RDW),hypersensitive C-reactive protein(hs-CRP),D-dimer,homocysteine(Hcy),IL 6,IL 10 at admission were compared among AIS patients with different TOAST classification.According to the results of NIHSS,mRS and ESRS scores at admission,univariate and multivariate binary logistic regression were used to analyze the factors affecting the degree of neurological impairment,prognosis and risk of recurrence in AIS patients.ROC curve was used to evaluate the effectiveness of laboratory indicates in predicting the degree of neurological impairment,prognosis and risk of recurrence in patients with AIS.Spearman rank correlation was used to analyze the correlation between NLR and NIHSS,mRS and ESRS scores in patients with AIS.Results There were significant differences in the age,NIHSS score,mRS score,ESRS score,N,NLR,RDW,hs-CRP,D-dimer,Hcy,IL 6 and IL-10 levels among AIS patients with different TOAST types(all P<0.05).Multivariate analysis showed that NLR was an independent factor affecting the degree of neurological impairment in AIS patients(P<0.05).NLR,hs-CRP and D-dimer were independent factors influencing the prognosis of neurological function in AIS patients(all P<0.05).NLR and D-dimer were independent factors influencing the risk of recurrence in AIS patients(both P<0.05).The area under the curve(AUC)of NLR for predicting degree of neurological impairment in AIS patients was 0.670,taking 2.52 as the best cut-off value,the sensitivity was 0.734 and specificity was 0.528.The AUC of NLR combined with hs-CRP and D-dimer was 0.781,using 0.40 as cut-off value for predicting neurological recovery in AIS patients,the sensitivity and specificity were 0.718 and 0.730,respectively.The AUC of NLR combined with D-dimer level was 0.736,using 0.42 as cut-off value for predicting the risk of recurrence in AIS patients,the sensitivity and specificity were 0.736 and 0.661,respectively.Spearman rank correlation analysis showed that NLR was positively correlated with NIHSS score,mRS score and ESRS score(rs=0.291,0.358,0.277,all P<0.001).Conclusion NLR has certain clinical value in the assessment of early neurological impairment,prognosis and risk of recurrence in patients with AIS.NLR combined with hs-CRP and D-dimer may effectively improve the evaluation efficiency of neurological prognosis in patients with AIS.