中性粒细胞与淋巴细胞比值和进展性缺血性卒中的关系研究

doi:10.3969/j.issn.1673-5765.2022.03.009

摘要/Abstract

摘要：

目的分析中性粒细胞与淋巴细胞比值（neutrophils to lymphocytes ratio，NLR）对进展性缺血性卒中（progressive ischemic stroke，PIS）发病的影响。

方法前瞻性连续纳入2019年4月-2020年11月濮阳市人民医院收治的急性缺血性卒中患者，根据发病1周内神经系统症状是否继续加重（NIHSS较入院时增加2分以上）将其分为PIS组和非进展性缺血性卒中（non-progressive ischemic stroke，NPIS）组。记录患者的性别、年龄、吸烟史、饮酒史、高血压病史、糖尿病病史、冠心病病史、入院NIHSS，入院次日采集空腹静脉血检验血脂、空腹血糖、Hcy、中性粒细胞计数（neutrophilic granulocyte count，NEUT）、淋巴细胞计数（lymphocyte granulocyte count，LYM）、CRP 水平，计算NLR。采用颈动脉彩超、MRA或CTA评估颈动脉粥样硬化斑块特点及血管狭窄情况。3个月随访患者的mRS，以mRS 0～2分为预后良好。比较两组间上述指标的差异，进一步采用多因素logistic回归分析NLR对PIS发病的影响，绘制ROC曲线，评价NLR对PIS的预测价值。

结果共纳入患者216例，PIS组98例，NPIS组118例。PIS组高血压病史（P =0.014）、糖尿病病史（P =0.039）、血管中-重度狭窄（P＜0.001）的比例高于NPIS组；实验室检查指标中空腹血糖（P＜0.001）、 Hcy（P =0.036）、NEUT（P＜0.001）、NLR（P＜0.001）、CRP（P＜0.001）水平高于NPIS，LYM水平低于NPIS 组（P＜0.001）。多因素logistic回归分析表明，糖尿病病史（OR 2.432，95%CI 1.065～5.553，P =0.035）、空腹血糖（OR 1.230，95%CI 1.036～1.461，P =0.018）、NEUT（OR 5.545，95%CI 1.151～26.710， P =0.033）、NLR（OR 1.519，95%CI 1.030～2.240，P =0.035）、CRP（OR 1.242，95%CI 1.073～1.436， P =0.004）、血管中-重度狭窄（OR 1.915，95%CI 1.321～2.776，P =0.001）均为PIS的独立危险因素。PIS 组3个月mRS高于NPIS组（中位数：2分 vs. 1分，P <0.001），预后良好率低于NPIS组（64.29% vs. 97.46%， P <0.001）。当NLR临界值为3.16时，诊断PIS的效能最佳，预测PIS的敏感度为79.4%，特异度为78.4%， AUC为0.822。

结论 PIS的发病与NLR密切相关，可作为临床早期PIS的预警参考指标。

文章导读： NLR是一种新型炎症指标，是PIS发病的危险因素，可作为PIS临床预警的参考指标。

关键词: 进展性缺血性卒中; 中性粒细胞/淋巴细胞比值; 空腹血糖; 血管狭窄; 危险因素

Abstract: Objective To explore the effect of neutrophils-to-lymphocytes ratio (NLR) on the pathogenesis of progressive ischemic stroke (PIS). Methods This study prospectively enrolled consecutive acute ischemic stroke patients in Puyang People's Hospital from April 2019 to November 2020. According to whether neurological symptoms worsened within 1 week of onset (NIHSS score increased by more than 2 points compared to admission), the patients were divided into PIS group and non-PIS (NPIS) group. Baseline clinical information were collected, including gender, age, history of smoking, drinking, hypertension, diabetes and coronary heart disease and admission NIHSS score, blood lipid, fasting blood-glucose, homocysteine (Hcy), neutrophilic granulocyte count (NEUT), lymphocyte granulocyte count (LYM), CRP level and NLR. The characteristics of carotid atherosclerotic plaque and vascular stenosis were evaluated by carotid color Doppler ultrasound, MRA or CTA. The prognosis was evaluated by 3-month mRS, and good prognosis was defined as a mRS score of 0-2. The baseline characteristics and 3-month prognosis between the two groups were compared. Multivariate logistic regression analysis was used to analyze the effect of NLR on PIS, and the ROC curve was used to evaluate the predictive value of NLR for PIS. Results A total of 216 patients were finally enrolled, with 98 in PIS group and 118 in NPIS group. PIS group had higher percentage of patients with hypertension (P =0.014), diabetes (P =0.039) and moderate to severe vascular stenosis (P <0.001) than NPIS group. The levels of fasting bloodglucose (P <0.001), Hcy (P =0.036), NEUT (P <0.001), NLR (P <0.001) and CRP level (P <0.001) in PIS group were higher than those in NPIS group, and the level of LYM in PIS group was lower than that in NPIS group (P <0.001). Multivariate logistic regression analysis showed that diabetes (OR 2.432, 95%CI 1.065-5.553, P =0.035), fasting blood-glucose (OR 1.230, 95%CI 1.036-1.461, P =0.018), NEUT (OR 5.545, 95%CI 1.151-26.710, P =0.033), NLR (OR 1.519, 95%CI 1.030-2.240, P =0.035), CRP level (OR 1.242, 95%CI 1.073-1.436, P =0.004) and moderate to severe vascular stenosis (OR 1.915, 95%CI 1.321-2.776, P =0.001) were independent risk factors for PIS. The 3-month mRS score of PIS group was higher than that of NPIS (median 2 vs . 1, P <0.001) and the good prognosis rate was lower than that of NPIS (64.29% vs . 97.46%, P <0.001). The optimal cutoff value of NLR for PIS was 3.16, with a sensitivity of 79.4% and a specificity of 78.4%, and the AUC value was 0.822. Conclusions NLR was closely related to the pathogenesis of PIS, which can be used as a predictor for early PIS.

Key words: Progressive ischemic stroke; Neutrophils to lymphocytes ratio; Fasting bloodglucose;Vascular stenosis; Risk factor

张芯蕾, 张顺清, 张亚玲, 王妍妍, 郭雅聪. 中性粒细胞与淋巴细胞比值和进展性缺血性卒中的关系研究[J]. 中国卒中杂志, 2022, 17(03): 272-277.

ZHANG Xinlei, ZHANG Shunqing, ZHANG Yaling, WANG Yanyan, GUO Yacong. The Relationship between Neutrophil to Lymphocyte Ratio and Progressive Ischemic Stroke[J]. Chinese Journal of Stroke, 2022, 17(03): 272-277.

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