中性粒细胞/淋巴细胞比值与脑梗死患者侧支循环建立的关系

Relationship Between Neutrophil/Lymphocyte Ratio and the Establishment of Collateral Circulation in Patients with Cerebral Infarction

目的分析大脑中动脉M1段重度狭窄或闭塞的患者中性粒细胞/淋巴细胞比值(NLR)与侧支循环的建立的关系。方法回顾性收集2019年1月-2022年1月就诊于自贡市第四人民医院神经内科,经DSA检查确诊为大脑中动脉M1段重度狭窄或闭塞的患者142例,根据是否建立侧支循环,分为侧支循环建立组和侧支循环未建立组。应用单因素及多因素Logistic回归分析探讨NLR是否为患者侧支循环建立独立危险因素。采用Spearman相关分析研究NLR与神经功能损伤程度及侧支循环代偿级别的相关性,并根据受试者工作特征(ROC)曲线确定NLR预测患者侧支循环未建立的最佳截断值。结果单因素分析结果显示,侧支循环未建立组NLR[10.79(7.13,14.63)]高于侧支循环建立组[7.24(5.39,10.41)],多元Logistic回归分析结果显示,NLR是影响侧支循环建立(OR=1.242,95%CI:1.101~1.402;P<0.01)的独立危险因素。Spearman相关分析显示NLR与NIHSS呈正相关(r=0.576,P<0.01),与侧支循环代偿级别呈负相关(r=-0.303,P<0.001);ROC曲线结果显示,NLR预测患者侧支循环未建立的临界值为9.365(曲线下面积是0.674,95%CI:0.559~0.788,敏感度61.3%,特异度70.3%)。结论对于大脑中动脉M1段重度狭窄或闭塞的患者,NLR与侧支循环建立相关,临床工作中,应重视NLR的测定。

Objective To analyze the relationship between neutrophil/lymphocyte ratio(NLR)and the establishment of collateral circulation in patients with severe stenosis or occlusion of M1 segment of middle cerebral artery.Methods A total of 142 patients with severe stenosis or occlusion of M1 segment of middle cerebral artery diagnosed by DSA in the Department of Neurology,Zigong Fourth People's Hospital from January 2019 to January 2022 were retrospectively collected.According to whether collateral circulation was established,they were divided into collateral circulation establishment group and collateral circulation non-establishment group.Univariate and multivariate logistic regression analysis were used to investigate whether NLR was an independent risk factor for collateral circulation in patients.Spearman correlation analysis was used to study the correlation between NLR and the degree of neurological impairment and the level of collateral circulation compensation.According to the receiver operating characteristic(ROC)curve,the optimal cut-off value of NLR for predicting the unestablished collateral circulation was determined.Results The results of univariate analysis showed that NLR[10.79(7.13,14.63)]in the collateral circulation non-establishment group was higher than that in the collateral circulation establishment group[7.24(5.39,10.41)].Multivariate logistic regression analysis showed that NLR affected the establishment of collateral circulation(OR=1.242,95%CI:1.101-1.402;P<0.01).Spearman correlation analysis showed that NLR was positively correlated with NIHSS(r=0.576,P<0.01)and negatively correlated with collateral circulation compensation level(r=-0.303,P<0.001).ROC curve results showed that the critical value of NLR for predicting unestablished collateral circulation was 9.365(area under the curve was 0.674,95%CI:0.559-0.788,sensitivity was 61.3%,specificity was 70.3%).Conclusion For patients with severe stenosis or occlusion of the M1 segment of the middle cerebral artery,NLR is associated with the establishment of collateral circulation.In clinical work,attention should be paid to the determination of NLR.