单核细胞/高密度脂蛋白胆固醇比值联合铁蛋白对急性缺血性脑卒中患者预后不良的预测价值

Predictive Value of Monocyte-to-High-Density Lipoprotein Cholesterol Ratio Combined with Ferritin on the Poor Prognosis of Patients with Acute Ischemic Stroke

目的探讨单核细胞/高密度脂蛋白胆固醇比值(MHR)联合铁蛋白对急性缺血性脑卒中(AIS)患者预后不良的预测价值。方法回顾性选取2020年1月—2022年5月河北北方学院附属第二医院收治的AIS患者255例为研究对象。收集患者临床资料,AIS发病后90 d采用改良Rankin量表(mRS)评估患者预后,mRS评分>2分为预后不良,mRS评分≤2分为预后良好。采用多因素Logistic回归分析探讨AIS患者预后不良的影响因素;采用Pearson相关分析探讨入院时MHR、铁蛋白与入院时美国国立卫生研究院卒中量表(NIHSS)、mRS评分的相关性;采用ROC曲线分析入院时MHR、铁蛋白及二者联合对AIS患者预后不良的预测价值。结果255例AIS患者中,预后良好组183例,预后不良组72例。预后不良组有心房颤动史者占比、入院时NIHSS评分、入院时mRS评分、使用抗凝药物治疗者占比、入院时单核细胞计数、入院时MHR、入院时铁蛋白高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,入院时NIHSS评分〔OR=1.172,95%CI(1.040~1.320)〕、入院时mRS评分〔OR=1.833,95%CI(1.205~2.789)〕、入院时MHR〔OR=31.639,95%CI(2.614~382.978)〕、入院时铁蛋白〔OR=1.006,95%CI(1.002~1.011)〕是AIS患者预后不良的独立影响因素(P<0.05)。Pearson相关分析结果显示,入院时MHR与入院时NIHSS、mRS评分呈正相关(P<0.05);入院时铁蛋白与入院时NIHSS、mRS评分呈正相关(P<0.05)。ROC曲线分析结果显示,入院时MHR预测AIS患者预后不良的AUC为0.702〔95%CI(0.623~0.780)〕,入院时铁蛋白预测AIS患者预后不良的AUC为0.784〔95%CI(0.729~0.840)〕,二者联合预测AIS患者预后不良的AUC为0.865〔95%CI(0.821~0.910)〕。结论入院时MHR、铁蛋白是AIS患者预后不良的独立影响因素,二者联合对AIS患者预后不良有一定预测价值。

Objective To explore the predictive value of monocyte-to-high-density lipoprotein cholesterol ratio(MHR)combined with ferritin on the pooRprognosis of patients with acute ischemic stroke(AIS).Methods A total of 255 AIS patients admitted to the Second Affiliated Hospital of Hebei North University from January 2020 to May 2022 were retrospectively selected as the research subjects.The clinical data of the patients were collected,90 days afteRthe onset of AIS,the prognosis of patients was evaluated by modified Rankin Scale(mRS),with mRS score>2 as pooRprognosis and mRS score≤2 as good prognosis.Multivariate Logistic regression analysis was used to explore the influencing factors of the pooRprognosis of patients with AIS.Pearson correlation analysis was used to explore the correlation between MHRand ferritin at admission and NIHSS and mRS scores at admission.The ROC curve was used to explore the predictive value of the MHRand ferritin at admission and their combination on the pooRprognosis of patients with AIS.Results Among 255 patients with AIS,there were 183 in good prognosis group and 72 in pooRprognosis group.The proportion of patients with atrial fibrillation history,NIHSS score at admission,mRS score at admission,the proportion of patients using anticoagulant therapy,monocyte count,MHRand ferritin in pooRprognosis group were higheRthan those in good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that NIHSS score at admission[OR=1.172,95%CI(1.040-1.320)],mRS score at admission[OR=1.833,95%CI(1.205-2.789)],MHRat admission[OR=31.639,95%CI(2.614-382.978)]and ferritin at admission[OR=1.006,95%CI(1.002-1.011)]were independent influencing factors of pooRprognosis of patients with AIS(P<0.05).Pearson correlation analysis showed that MHRat admission was positively correlated with NIHSS and mRS scores at admission(P<0.05),ferritin at admission was positively correlated with NIHSS and mRS scores at admission(P<0.05).ROC curve analysis showed that the AUC of the MHRat admission foRpredicting pooRprognosis of patients with AIS was 0.702[95%CI(0.623-0.780)],the AUC of the ferritin at admission foRpredicting poor prognosis of patients with AIS was 0.784[95%CI(0.729-0.840)],the AUC of the theiRcombination foRpredicting pooRprognosis of patients with AIS was 0.865[95%CI(0.821-0.910)].Conclusion MHRand ferritin at admission are independent influencing factors of pooRprognosis of patients with AIS,and theiRcombination has certain predictive value foRpooRprognosis of patients with AIS.