全身免疫炎症指数及美国国立卫生研究院卒中量表评分对急性缺血性脑卒中患者静脉溶栓后短期预后的评估效力分析

Efficacy of systemic immune inflammation index and National Institutes of HealthStroke Scale score on evaluating the short-term prognosis of patients with acuteischemic stroke receiving intravenous thrombolysis

目的 探究入院时全身免疫炎症指数(systemic immune-inflammation index, SII)及溶栓后即刻美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评分对急性缺血性脑卒中(acute ischemic stroke, AIS)并接受静脉溶栓治疗的患者短期神经功能预后的评估效力。方法 回顾性分析2022年3月—2023年3月就诊于成都市第二人民医院行静脉溶栓治疗的AIS患者,收集患者基本资料、急诊入院时NIHSS评分、溶栓后即刻NIHSS评分、出院后3个月改良Rankin量表(modified Rankin Scale, mRS)评分以及入院时实验室资料,并计算入院时SII。根据出院后3个月mRS评分,将患者分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分>2分)。运用多因素logistic回归分析方法筛选出影响患者预后的因素,并绘制受试者操作特征曲线分析入院时SII、溶栓后即刻NIHSS评分对患者短期内神经功能预后不良的评估效力。结果 共纳入213例患者,其中预后不良者88例。多因素logistic回归分析显示:年龄、发病距溶栓时间、入院时尿酸、入院时SII、入院后空腹血糖、溶栓后即刻NIHSS评分是AIS患者溶栓后短期预后不良的独立危险因素(P<0.05)。入院时SII预估患者预后不良的受试者操作特征曲线下面积(area under the curve, AUC)为0.715,灵敏度为55.7%,特异度为84.0%;溶栓后即刻NIHSS评分预估患者预后不良的AUC为0.866,灵敏度为87.5%,特异度为72.8%;入院时SII联合溶栓后即刻NIHSS评分预估患者预后不良的AUC为0.875,灵敏度为84.1%,特异度为77.6%,阳性预测值为72.5%,阴性预测值为87.4%。入院时SII与急诊入院时NIHSS评分、溶栓后即刻NIHSS评分、出院后3个月mRS评分均呈正相关(P<0.05)。结论 入院时SII能预测AIS患者溶栓治疗后短期神经功能预后,与溶栓后即刻NIHSS评分联合可提高预估效能。

Objective To investigate the efficacy of systemic immune inflammation index(SII)at admission and National Institutes of Health Stroke Scale(NIHSS)score immediately after thrombolysis on evaluating the short-term prognosis of neurological function in patients with acute ischemic stroke(AIS)receiving intravenous thrombolysis.Methods Patients with AIS treated with intravenous thrombolysis in the Second People’s Hospital of Chengdu between March 2022 and March 2023 were retrospectively analyzed.The basic data of the patients,NIHSS score at emergency admission,NIHSS score immediately after thrombolysis,modified Rankin Scale(mRS)score 3 months after discharge,and laboratory data at admission were collected, and SII at admission was calculated. According to the mRS score3 months after discharge, the patients were divided into the good prognosis group (mRS≤2) and the poor prognosis group(mRS>2). Multivariate logistic regression analysis was used to screen out the factors affecting the prognosis of patients,and the receiver operating characteristic curve was drawn to analyze the evaluation effect of SII at admission and NIHSSscore immediately after thrombolysis on the poor prognosis of neurological function of patients in the short term. Results A total of 213 patients were enrolled, and the prognosis was poor in 88 patients. Multivariate logistic regression analysisshowed that age, onset-to-needle time, uric acid at admission, SII at admission, fasting blood glucose after admission, andNIHSS score immediately after thrombolysis were independent risk factors for poor prognosis in AIS patients (P<0.05).The area under the receiver operating characteristic curve (AUC) of SII at admission for predicting poor prognosis was0.715, the sensitivity was 55.7%, and the specificity was 84.0%. The AUC of NIHSS score immediately after thrombolysisfor predicting poor prognosis of patients was 0.866, the sensitivity was 87.5%, and the specificity was 72.8%. The AUC ofSII at admission combined with NIHSS score immediately after thrombolysis for predicting poor prognosis of patients was0.875, the sensitivity was 84.1%, the specificity was 77.6%, the positive predictive value was 72.5%, and the negativepredictive value was 87.4%. SII at admission was positively correlated with NIHSS score at emergency admission, NIHSSscore immediately after thrombolysis, and mRS score 3 months after discharge (P<0.05). Conclusion SII at admissioncan predict the short-term prognosis of neurological function of patients with AIS after thrombolysis therapy, and thecombination of SII at admission and NIHSS score immediately after thrombolysis can improve the prediction efficiency.