系统性免疫炎症指数、C反应蛋白/白蛋白比值对急性缺血性卒中患者溶栓后短期预后的评估价值

doi:10.3969/j.issn.1673-5765.2024.12.012

摘要/Abstract

摘要： 目的探讨系统性免疫炎症指数（systemic immune-inflammation index，SII）、CRP/白蛋白（albumin，ALB）对接受rt-PA溶栓治疗的急性缺血性卒中（acute ischemic stroke，AIS）患者短期预后的预测作用。
方法回顾性分析彭州市人民医院2022年1—12月收治的接受rt-PA溶栓治疗的AIS患者临床病例资料。采用mRS评估患者发病后30 d预后情况，mRS评分≤2分为预后良好，mRS评分>3分为预后不良。采集入院时外周血检验结果计算SII和CRP/ALB。单因素和logistic多因素分析AIS患者预后的影响因素。采用ROC曲线分析SII、CRP/ALB对AIS患者预后的预测作用。
结果本研究共纳入134例AIS患者，其中预后不良者29例（21.64%）。单因素分析发现，预后不良患者入院时NIHSS评分、血小板计数、D-二聚体、凝血酶原时间、TC、CRP、SII、CRP/ALB高于预后良好患者，差异有统计学意义（P<0.05）；预后不良患者淋巴细胞计数、ALB低于预后良好患者，差异有统计学意义（P<0.05）。logistic多因素分析显示入院时NIHSS评分（OR 19.028，95%CI 2.785～27.348，P<0.001）、TC（OR 6.979，95%CI 1.851～12.191，P=0.009）、CRP（OR 7.830，95%CI 2.559～14.252，P=0.002）、ALB（OR 0.192，95%CI 0.101～0.662，P＜0.001）、SII（OR 9.244，95%CI 2.571～19.379，P<0.001）、CRP/ALB（OR 11.100，95%CI 3.570～22.451，P<0.001）是患者预后不良的独立影响因素。ROC曲线分析显示SII、CRP/ALB对预后不良具有预测价值，AUC分别为0.648（95%CI 0.529～0.767，P=0.015）和0.749（95%CI 0.664～0.883，P<0.001），敏感度分别为0.448、0.931，特异度分别为0.876、0.562。
结论 SII和CRP/ALB是患者预后不良的独立影响因素，联合SII、CRP/ALB评估，有助于早期识别高危AIS患者。

文章导读： 本研究通过回顾性分析发现SII和CRP/ALB是急性缺血性卒中患者溶栓后短期预后不良的影响因素，对预后评估具有一定价值。

关键词: 急性缺血性卒中; 系统性免疫炎症指数; C反应蛋白/白蛋白; 溶栓; 阿替普酶; 预后

Abstract: Objective To investigate the predictive effects of systemic immune-inflammation index (SII) and CRP/albumin (ALB) on short-term prognosis of acute ischemic stroke (AIS) patients receiving thrombolytic therapy with rt-PA.
Methods The clinical data of AIS patients who received rt-PA thrombolytic therapy in The People’s Hospital of Pengzhou from January to December 2022 were retrospectively analyzed. The mRS was used to evaluate the prognosis of patients 30 days after the onset of the disease. The mRS score of≤2 points was considered a good prognosis, while mRS score>3 points was considered a poor prognosis. SII and CRP/ALB were calculated from peripheral blood test results at admission. The factors influencing prognosis of AIS patients were analyzed by univariate and logistic multivariate analysis. The predictive effects of SII and CRP/ALB on the prognosis of AIS patients were analyzed using the ROC curve.
Results A total of 134 AIS patients were included in this study, of which 29 patients (21.64%) had poor prognosis. Univariate analysis showed that NIHSS score, platelet count, D-dimer, prothrombin time, TC, CRP, SII, and CRP/ALB in patients with poor prognosis were higher than those with good prognosis, and the differences were statistically significant (P<0.05). The lymphocyte count and ALB in patients with poor prognosis were lower than those with good prognosis, and the differences were statistically significant (P<0.05). Logistic multivariate analysis showed that NIHSS score (OR 19.028, 95%CI 2.785-27.348, P<0.001), TC (OR 6.979, 95%CI 1.851-12.191, P=0.009), CRP (OR 7.830, 95%CI 2.559-14.252, P=0.002), ALB (OR 0.192, 95%CI 0.101-0.662, P＜0.001), SII (OR 9.244, 95%CI 2.571-19.379, P<0.001), and CRP/ALB (OR 11.100, 95%CI 3.570-22.451, P<0.001) were independent influencing factors of poor prognosis. ROC curve analysis showed that SII and CRP/ALB had predictive value for poor prognosis, with AUC of 0.648 (95%CI 0.529-0.767, P=0.015) and 0.749 (95%CI 0.664-0.883, P<0.001), sensitivity of 0.448 and 0.931, and specificity of 0.876 and 0.562, respectively.
Conclusions SII and CRP/ALB are independent influencing factors for poor prognosis of patients, and combined assessment of SII and CRP/ALB is helpful for early identification of high-risk AIS patients.

Key words: Acute ischemic stroke; Systemic immune-inflammation index; C-reactive protein/albumin; Thrombolysis; Alteplase; Prognosis

中图分类号:

刘晓梅, 苟重季, 付丽. 系统性免疫炎症指数、C反应蛋白/白蛋白比值对急性缺血性卒中患者溶栓后短期预后的评估价值[J]. 中国卒中杂志, 2024, 19(12): 1448-1453.

LIU Xiaomei, GOU Zhongji, FU Li. Evaluation Value of Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio in Short-Term Prognosis of Patients with Acute Ischemic Stroke after Thrombolytic Therapy[J]. Chinese Journal of Stroke, 2024, 19(12): 1448-1453.

参考文献

[1] 吕苏，宋小静，高伟波，等. 血小板相关指数与溶栓后急性脑卒中患者预后的关系[J]. 中华急诊医学杂志，2021，30（3）：301-306.
LYU S，SONG X J，GAO W B，et al. The relationship between platelet volume-related indices for the prognosis of acute ischemic stroke with intravenous thromblysys[J]. Chin J Emerg Med，2021，30（3）：301-306.
[2] ZHU F，JI Y，SONG J H，et al. Correlations between NLR，NHR，and clinicopathological characteristics，and prognosis of acute ischemic stroke[J/OL]. Medicine（Baltimore），2023，102（24）：e33957[2023-09-10]. https://doi.org/10.1097/MD.0000000000033957.
[3] XIA Y Y，XIA C L，WU L D，et al. Systemic immune inflammation index（SII），system inflammation response index（SIRI）and risk of all-cause mortality and cardiovascular mortality：a 20-year follow-up cohort study of 42 875 US adults[J/OL]. J Clin Med，2023，12（3）：1128[2023-09-10]. https://doi.org/10.3390/jcm12031128.
[4] 赵东波，黄樱，何扬，等. 血清CRP／ALB比值诊断糖尿病酮症酸中毒合并感染的价值[J]. 中华医院感染学杂志，2021，14（31）：2095-2098.
ZHAO D B，HUANG Y，HE Y，et al. Values of serum CRP/ALB ratio in diagnosis of infection in diabetic ketoacidosis patients[J]. Chinese Journal of Nosocomiology，2021，14（31）：2095-2098.
[5] LI S J，XIA Z G，CAO J Z，et al. Proposed new prognostic model using the systemic immune-inflammation index for primary central nervous system lymphoma：a prospective-retrospective multicohort analysis[J/OL]. Front Immunol，2022，9（13）：1039862[2023-09-10]. https://doi.org/10.3389/fimmu.2022.1039862.
[6] 马新，杨洁，杨小英. 系统免疫炎症指数、纤维蛋白原/清蛋白比值对急性缺血性脑卒中病情严重程度和短期预后的评估价值[J]. 国际检验医学杂志，2022，21（43）：2639-2644.
MA X，YANG J，YANG X Y. The clinical value of system immune inflammation index and fibrinogen to albumin ratio in severity and short-term prognosis of acute ischemic stroke[J]. International Journal of Laboratory Medicine，2022，21（43）：2639-2644.
[7] 杨汉才，许志定，彭可科，等. CRP/ALB 比值对老年急性缺血性脑卒中患者卒中相关性肺炎的预测价值[J]. 解放军医药杂志，2020，5（32）：94-98.
YANG H C，XU Z D，PENG K K，et al. Predictive value of CRP/ALB ratio for stroke-associated pneumonia in elderly patients with acute ischemic stroke[J]. Medical & Pharmaceutical Journal of Chinese People’s Liberation Army，2020，5（32）：94-98.
[8] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，9（51）：666-682.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，9（51）：666-682.
[9] QUINN T J，DAWSON J，WALTERS M R，et al. Reliability of the modified Rankin scale：a systematic review[J]. Stroke，2009，40（10）：3393-3395．
[10] HINKLEI J L. Reliability and validity of the National Institutes of Health stroke scale for neuroscience nurses[J/OL]. Stroke，2014，45（3）：e32-e34[2023-09-10]. https://doi.org/10.1161/STROKEAHA.113.004243.
[11] HU Y H，HUANG K B，JI Z，et al. High neutrophil-to-lymphocyte ratio is associated with poor clinical outcome in patients with critically ill stroke[J]. Minerva Anestesiol，2020，86（9）：939-947.
[12] XIE K H，LIU L L，LIANG Y R，et al. Red cell distribution width：a novel predictive biomarker for stroke risk after transient ischaemic attack[J]. Ann Med，2022，54（1）：1167-1177.
[13] 刘忠，刘媛媛，徐少峰，等. 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，2022，3（17）：285-291.
LIU Z，LIU Y Y，XU S F，et al. Correlation analysis of systemic immune-inflammatory index with severity and prognosis of acute ischemic stroke[J]. Chin J Stroke，2022，3（17）：285-291.
[14] WU J J，HAN G S，SHA Y H，et al. Mechanisms of in-hospital acute ischemic stroke and their relevance to prognosis：a retrospective analysis[J/OL]. J Stroke Cerebrovasc Dis，2023，32（6）：107105[2023-09-10]. https://doi.org/10.1016/j.jstrokecerebrovasdis. 2023.107105.
[15] 胡萍，崔妙玲，蒋云. 急性脑卒中外周血白细胞Ｃ反应蛋白的变化与短期预后的关系[J]. 中国实用神经疾病杂志，2020，23（2）：98-101.
HU P，CUI M L，JIANG Y，et al. The relationship between short-term prognosis and changes of white blood cells and C-reactive protein in patients with acute stroke[J]. Chinese Journal of Practical Nervous Diseases，2020，23（2）：98-101.
[16] FINCK T，SPERL P，HERNANDEZ-PETZSCHE M，et al. Inflammation in stroke：initial CRP levels can predict poor outcomes in endovascularly treated stroke patients[J/OL]. Front Neurol，2023，9（14）：1167549[2023-09-10]. https://doi.org/10.3389/fneur.2023.1167549.
[17] 李艳彬，李博，马金辉，等. 血清ALB、Hb及衰弱状态与脑卒中后认知障碍的关系及临床意义[J]. 中国医师杂志，2022，5（24）：770-774.
LI Y B，LI B，MA J H，et al. Relationship and clinical significance of serum ALB，Hb and frailty state with cognitive impairment after stroke[J]. Journal of Chinese Physician，2022，5（24）：770-774.
[18] DROZDOWSKA B A，ELLIOTT E，TAYLOR-BOWAN M，et al. Cardiovascular risk factors in directly affect acute post-stroke cognition through stroke severity and prior cognitive impairment：a moderated mediation analysis[J/OL]. Alzheimers Res Ther，2020，12（1）：85[2023-09-10]. https://doi.org/10.1186/s13195-020-00653-y.
[19] 李淑恩，郑伟城，林显仙，等. 脑梗死急性期低白蛋白血症与卒中后认知障碍相关性研究[J]. 中国神经精神疾病杂志，2020，46（2）：75-79.
LI S E，ZHENG W C，LIN X X，et al. Hypoalbuminemia in acute ischemic stroke is associated with post-stroke cognitive impairment at 6 months[J]. Chin J Nerv Ment Dis，2020，46（2）：75-79.
[20] XU N，PENG C. Association between red cell distribution width-to-platelet ratio and short-term and long-term mortality risk in patients with acute ischemic stroke[J/OL]. BMC Neurol，2023，23（1）：191[2023-09-10]. https://doi.org/10.1186/s12883-023-03219-1.
[21] YANG F，LIU J T，CHEN L F，et al. Impact of lymphocyte-related blood parameters on short-and long-term outcomes of patients undergoing thoracic endovascular aortic repair[J]. Angiology，2021，72（10）：953-960.
[22] PEKTEZEL M Y，YILMAZ E，ARSAVA E M，et al. Neutrophil-to-lymphocyte ratio and response to intravenous thrombolysis in patients with acute ischemic stroke[J]. J Stroke Cerebrovasc Dis，2019，28（7）：1853-1859.
[23] HUANG L. Increased systemic immune-inflammation index predicts disease severity and functional outcome in acute ischemic stroke patients[J]. Neurologist，2023，28（1）：32-38.
[24] KOCATÜRK M，KOCATÜRK Ö. Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke[J]. Neurol Neurochir Pol，2019，53（3）：205-211.