系统免疫炎性指数与急性缺血性卒中严重程度及预后的相关性分析

doi:10.3969/j.issn.1673-5765.2022.03.011

摘要/Abstract

摘要：

目的探讨系统免疫炎性指数（systemic immune-inflammation index，SII）与急性缺血性卒中患者入院时严重程度及90 d预后的关系。

方法本研究数据来源于脑卒中防治工程管理专项数据库，从数据库中连续筛选2020年8月-2021年8月烟台毓璜顶医院急诊科收治的首次发病24 h内的缺血性卒中患者的临床资料进行回顾性分析。收集患者入院3 h内NIHSS评分，将NIHSS>5分者作为中重度卒中组，NIHSS≤5分者作为轻度卒中组，比较轻度组与中重度组患者基线资料的差异。收集患者发病90 d的mRS评分，以mRS>2分者作为预后不良组，mRS≤2分者作为预后良好组，比较在轻度卒中组、中重度卒中组中，预后良好与预后不良患者基线资料的差异。采用多因素logistic回归分析SII、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、血小板与淋巴细胞比值（platelet to lymphocyte ratio，PLR）与病情严重程度的相关性及对患者预后的影响。根据所有患者的资料绘制ROC曲线分析SII、NLR和PLR对预后不良的预测价值。

结果研究纳入轻度卒中组168例（63.2%），中重度卒中组98例（36.8%）；轻度卒中组内有44 例（26.2%）预后不良，中重度卒中组内有56例（57.1%）预后不良。logistic回归分析结果显示：高 SII（OR 1.004，95%CI 1.001～1.006，P =0.007）、高NLR（OR 1.189，95%CI 1.081～1.324，P =0.004）与急性缺血性卒中患者入院时病情严重程度相关；对于轻度卒中组患者，高SI I（OR 1.016，95%CI 1.005～1.032，P =0.016）、高NLR（OR 1.167，95%CI 1.045～1.302，P =0.005）是缺血性卒中90 d预后不良的独立危险因素；对于中重度卒中组患者，高SI（I OR 1.010，95%CI 1.006～1.011，P=0.025）、高 NLR（OR 1.142，95%CI 1.022～1.283，P =0.020）、高PLR（OR 1.003，95%CI 1.000～1.010，P =0.032）是缺血性卒中90 d预后不良的独立危险因素。SII、NLR、PLR预测90 d预后的AUC值分别为0.750（95%CI 0.692～0.808）、0.704（95%CI 0.637～0.772）、0.742（95%CI 0.692～0.808），差异有统计学意义（P <0.05）。

结论 SII与首次急性缺血性卒中患者入院时病情严重程度相关，且是其90 d预后不良的危险因素， SII在预测急性缺血性卒中90 d预后不良方面较NLR及PLR更加准确。

文章导读： SII的水平与初次发病的缺血性卒中患者入院时严重程度及90 d预后不良相关，并且SII在预测缺血性卒中患者90 d预后不良方面较NLR及PLR更加准确。

关键词: 急性缺血性卒中; 系统免疫炎性指数; 中性粒细胞与淋巴细胞比值; 血小板与淋巴细胞比值; 严重程度; 预后

Abstract: Objective To investigate the relationship between systemic immune-inflammatory index (SII) and stroke severity at admission and 90-day prognosis in patients with acute ischemic stroke (AIS). Methods This retrospective study enrolled the AIS patients who were admitted within 24 hours after the first stroke onset from the database of Stroke Prevention and Treatment Engineer Management Project from August 2020 to August 2021. The differences in baseline characteristics between the mild stroke (NIHSS≤5) group and moderate-severe stroke (NIHSS>5) group and between the good prognosis (mRS≤2) group and poor prognosis (mRS>2) group were compared. The logistic regression analysis was used to analyze the correlation between SII, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and stroke severity at admission and 90-day prognosis. The AUC analysis was used to evaluate the prognostic value of SII, NLR, and PLR for poor prognosis. Results This study included 168 cases (63.2%) in mild stroke group and 98 cases (36.8%) in moderate-severe stroke group. 44 cases (26.2%) had poor prognosis in mild stroke group and 56 cases (57.1%) in moderate-severe stroke group. The logistic regression analysis showed that high SII (OR 1.004, 95%CI 1.001-1.006, P =0.007), and high NLR (OR 1.189, 95%CI 1.081-1.324, P =0.004) were correlated with stroke severity at admission; high SII (OR 1.016, 95%CI 1.005-1.032, P =0.016) and high NLR (OR 1.167, 95%CI 1.045-1.302, P =0.005) were independent risk factors for 90-day prognosis in mild stroke group; high SII (OR 1.010, 95%CI 1.006-1.011, P =0.025), high NLR (OR 1.142, 95%CI 1.022-1.283, P =0.020), and high PLR (OR 1.003, 95%CI 1.000-1.010, P =0.032) were independent risk factors for 90-day prognosis in moderate-severe stroke group. The AUC value of SII, NLR and PLR for 90-day prognosis were 0.750 (95%CI 0.692-0.808), 0.704 (95%CI 0.637-0.772), and 0.742 (95%CI 0.692-0.808), respectively (P <0.05). Conclusions High SII was correlated with stroke severity at admission and was a risk factor for 90-day prognosis, and SII had higher prognostic value for 90-day poor prognosis than NLR and PLR in AIS patients.

Key words: Acute ischemic stroke; Systemic immune-inflammatory index; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio; Severity; Prognosis

刘忠, 刘媛媛, 徐少峰, 郭伟, 康海. 系统免疫炎性指数与急性缺血性卒中严重程度及预后的相关性分析[J]. 中国卒中杂志, 2022, 17(03): 285-291.

LIU Zhong, LIU Yuanyuan, XU Shaofeng, GUO Wei, KANG Hai. Correlation Analysis of Systemic Immune-Inflammatory Index with Severity and Prognosis of Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2022, 17(03): 285-291.

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