术前NLR对急性大脑中动脉闭塞血管内治疗患者不良预后的预测价值

Prognostic value of preoperative NLR in patients undergoing endovascular therapy

目的探讨急性大脑中动脉(MCA)闭塞患者在接受血管内治疗(EVT)前,术前外周血中性粒细胞与淋巴细胞计数比值(NLR)与发病后90 d不良预后之间的关系,并评估其预测价值。方法收集2021-01—2023-07于徐州市中心医院高级卒中中心接受血管内治疗的急性MCA闭塞患者的临床资料。根据患者发病后90 d预后情况分为良好预后组和不良预后组。采用单因素及多因素Logistic回归分析探讨各因素与不良预后的关系,采用线性回归分析探讨术前NLR与各因素间的相关性,同时绘制预后情况的受试者操作特征(ROC)曲线,并计算曲线下面积(AUC)和最佳临界值。结果最终纳入急性MCA闭塞血管内治疗患者97例,良好预后组32例(32.99%),不良预后组65例(67.01%)。单因素分析显示,在年龄、术前NLR、术前ASPECT评分及侧支循环情况方面,不良预后组低于良好预后组(分别为P=0.007、0.022、<0.001、0.007),术前NIHSS评分、术前血糖高于良好预后组(P=0.014、0.003)。2组在性别、既往史(高血压、糖尿病、冠心病、房颤、脑卒中、高血脂)、术前血压、病因分型、有无静脉溶栓、发病到血管再通时间、发病到穿刺成功时间、改良脑梗死溶栓治疗分级(mTICI)、术前中性粒细胞及淋巴细胞数量方面差异无统计学意义(P>0.05)。多元线性回归分析显示年龄、术前NIHSS评分、术前舒张压可影响术前NLR大小(分别为P=0.007、0.009、0.011)。多因素Logistic回归分析显示年龄(OR=1.055,95%CI:1.008~1.105)、术前ASPECT评分(OR=0.562,95%CI:0.366~0.861)、术前NLR(OR=1.17,95%CI:1.003~1.367)是急性大脑中动脉闭塞血管内治疗患者不良预后的独立危险因素(分别为P=0.022、0.008、0.046)。术前NLR预测急性MCA血管内治疗患者发病后90 d不良预后的AUC为0.644(95%CI:0.526~0.761),最佳临界值为3.255。结论术前NLR与急性MCA闭塞EVT治疗患者的不良预后存在相关性,且可作为预测此类患者不良预后的指标。

Objective To investigate the relationship between preoperative peripheral blood neutrophil to lymphocyte count ratio(NLR)and poor prognosis 90 days after onset in patients with acute middle cerebral artery(MCA)occlusion before endovascular therapy(EVT),and evaluate its predictive value.Methods Data were collected from patients with acute MCA occlusion who received endovascular therapy at the Advanced Stroke Center of Xuzhou Central Hospital from January 2021 to July 2023.In this study,patients were divided into good prognosis group and poor prognosis group according to telephone return visit or outpatient follow-up 90 days after the onset of the disease.Univariate and multivariate Logistic regression analysis was used to investigate the relationship between factors and poor prognosis,linear regression analysis was used to investigate the correlation between preoperative NLR and factors,and the receiver operating characteristic(ROC)curve of prognosis was plotted,and the area under the curve(AUC)value and the optimal critical value were calculated.Results In this study,97 patients with acute MCA intravascular therapy were included,including 32 patients(32.99%)in the good prognosis group and 65 patients(67.01%)in the poor prognosis group.Univariate analysis showed that in terms of age,preoperative NLR,preoperative ASPECT score and collateral circulation,the poor prognosis group was lower than that of the good prognosis group(P=0.007,0.022,<0.001,0.007,respectively),and the preoperative NIHSS score and preoperative blood glucose score were higher than those of the good prognosis group(P=0.014,0.003,respectively).There were no statistically significant differences between the two groups in gender,past history(hypertension,diabetes,coronary heart disease,atrial fibrillation,stroke,hyperlipidemia),preoperative blood pressure,etiology type,presence or absence of intravenous thrombolysis,time from onset to vascularization,time from onset to successful puncture,modified thrombolysis classification for cerebral infarction(mTICI),and the number of neutrophils and lymphocytes before surgery(P>0.05).Multiple linear regression analysis showed that age,preoperative NIHSS score and preoperative diastolic blood pressure could affect preoperative NLR size(P=0.007,0.009,0.011,respectively).Multivariate Logistic regression analysis showed age(OR=1.055,95%CI:1.008-1.105),preoperative ASPECT score(OR=0.562,95%CI:0.366-0.861),preoperative NLR(OR=1.17,95%CI:1.003-1.367)were independent risk factors for poor prognosis in patients treated with acute middle cerebral artery occlusion(P=0.022,0.008,0.046,respectively).Preoperative NLR predicted an AUC of 0.644(95%CI:0.526-0.761)for adverse prognosis 90 days after the onset of acute intravascular MCA,and the optimal cutoff was 3.255.Conclusion Preoperative NLR is associated with poor prognosis in patients with acute MCA occlusion treated by EVT,and can be used as a predictor of poor prognosis in such patients.