中国卒中杂志 ›› 2020, Vol. 15 ›› Issue (02): 141-145.DOI: 10.3969/j.issn.1673-5765.2020.02.006

• 论著 • 上一篇    下一篇

单核细胞与高密度脂蛋白胆固醇比值与急性缺血性卒中静脉溶栓短期预后的关系

刘红兵,刘凯,裴璐璐,高远,赵璐,方慧,宋波,许予明   

  1. 450052郑州大学第一附属医院神经内科;河南省脑血管病重点实验室
  • 收稿日期:2019-09-13 出版日期:2020-02-20 发布日期:2020-02-20
  • 通讯作者: 许予明 xuyuming@zzu.edu.cn

Relationship between Monocyte-to-HDL Cholesterol Ratio and Short-term Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

  • Received:2019-09-13 Online:2020-02-20 Published:2020-02-20

摘要:

目的 探讨单核细胞与HDL-C比值(monocyte-to-HDL cholesterol ratio,MHR)与急性缺血性卒中 (acute ischemic stroke,AIS)静脉溶栓短期预后的关系。 方法 回顾性纳入2015年1月1日-2017年12月1日在郑州大学第一附属医院神经内科急诊接受静脉 溶栓治疗的AIS患者。患者预后通过90 d mRS来评估,良好预后定义为mRS评分≤2分。采用多因素 Logistic回归分析MHR及其他基线资料与90 d预后的关系,应用ROC曲线评价MHR对预后的预测价值。 结果 共纳入281例患者,平均年龄59.54±12.49岁,男性183例(65.1%),良好预后223例(79.4%)。 多因素Logistic回归分析显示,高龄(OR 1.03,95%CI 1.01~1.06,P =0.013)、溶栓前NI HSS评分高(OR 1.31,95%CI 1.17~1.44,P<0.001)和高MHR(OR 2.39,95%CI 1.10~5.25,P =0.028)是AIS静脉溶栓患 者90 d不良预后的独立影响因素。亚组分析显示,高MHR(OR 5.15,95%CI 1.28~20.77,P =0.021)是 大动脉粥样硬化型AIS静脉溶栓90 d不良预后的独立影响因素。ROC曲线分析显示,MHR预测预后不良 的最佳界值为0.48,其敏感度和特异度分别为79.41%和58.33%。 结论 MHR是AIS尤其大动脉粥样硬化型静脉溶栓短期预后的独立影响因素。

文章导读: MHR作为一种新的炎症标志物,可以作为急性缺血性卒中静脉溶栓后短期不良预后的预测因素,为急性缺血性卒中临床治疗及预后改善提供理论依据。

关键词: 急性缺血性卒中; 单核细胞; 高密度脂蛋白; 溶栓; 预后

Abstract:

Objective To investigate the relationship between monocyte-to-HDL cholesterol ratio (MHR) and short-term prognosis in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis. Methods A retrospective analysis of consecutive AIS patients treated with intravenous thrombolysis in Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2017 was undertaken. Functional outcome at 90 days was evaluated by the mRS. Good outcome was defined as a mRS score of 0-2. Multivariate logistic regression analysis was conducted to evaluate the relationship between MHR and 90-day outcome. The ROC curve analysis was performed to evaluate the predictive value. Results A total of 281 patients were included, with an average age of 59.54±12.49 years and 183 males (65.1%). 223 cases (79.4%) had good prognosis. Multivariate analysis showed that higher age (OR 1.03, 95%CI 1.01-1.06, P=0.013), baseline NIHSS score (OR 1.31, 95%CI 1.17-1.44, P<0.001) and MHR (OR 2.39, 95%CI 1.10-5.25, P=0.028) were independent predictors for 90-day poor prognosis. Subgroup analysis showed that high MHR (OR 5.15, 95%CI 1.28-20.77, P=0.021) was an independent predictor for 90-day poor prognosis in patients with large atherosclerotic stroke. ROC curve analysis showed that the optimal cut-off point of MHR was 0.48, and the sensitivity and specificity of predicting short-term poor prognosis were 79.41% and 58.33%. Conclusions MHR was an independent predictor for short-term prognosis after venous thrombolysis in AIS patients, especially in patients with large atherosclerotic stroke.

Key words: Acute ischemic stroke; Monocyte; High density lipoprotein; Thrombolysis;Prognosis