炎症标志物动态变化对急性缺血性卒中患者血管内治疗预后的影响

doi:10.3969/j.issn.1673-5765.2025.02.006

摘要/Abstract

摘要： 目的探讨急性大血管闭塞性缺血性卒中（acute ischemic stroke with large vessel occlusion，LVO-AIS）患者血管内治疗（endovascular treatment，EVT）术前、术后24 h炎症标志物水平及其动态变化与3个月预后的关系。
方法回顾性连续纳入2017年4月—2021年10月在苏州大学附属第二医院接受EVT的LVO-AIS患者，根据术后3个月mRS评分分为预后良好（mRS评分0～2分）组与预后不良（mRS评分3～6分）组。收集两组患者的年龄、性别、既往史、术前与术后24 h炎症反应相关指标[中性粒细胞（neutrophil，NEUT）、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、全身性炎症反应指数（systemic inflammation response index，SIRI）等]资料。通过logistic回归分析探讨炎症标志物与患者不良预后、症状性颅内出血（symptomatic intracranial hemorrhage，sICH）的相关性。
结果共纳入354例LVO-AIS患者，其中预后良好组120例（33.90%），预后不良组234例（66.10%）。多因素logistic回归分析显示，EVT术后24 h NEUT（OR 1.24，95%CI 1.12～1.37，P<0.001）、NLR（OR 1.09，95%CI 1.03～1.14，P=0.001）、SIRI（OR 1.14，95%CI 1.05～1.23，P=0.002）是3个月不良预后的独立危险因素。EVT术后24 h NEUT（OR 1.23，95%CI 1.11～1.36，P<0.001）、NLR（OR 1.06，95%CI 1.03～1.10，P<0.001）、SIRI（OR 1.08，95%CI 1.02～1.14，P=0.005）是患者发生sICH的独立危险因素。
结论术后炎症标志物NEUT、NLR、SIRI的动态升高可能增加LVO-AIS患者EVT后3个月不良预后的风险。

文章导读： 本研究探讨了炎症标志物NEUT、NLR、SIRI的动态变化对急性缺血性卒中患者血管内治疗预后的影响，发现血管内治疗术后24 h NEUT、NLR、SIRI升高与3个月不良预后和sICH发生风险显著相关，为血管内治疗患者的抗炎治疗提供了依据和初步靶点。

关键词: 缺血性卒中; 血管内治疗; 预后; 炎症标志物; 大血管闭塞

Abstract: Objective To explore the relationship between the levels of inflammatory markers before and 24 hours after endovascular treatment (EVT) in patients with acute ischemic stroke with large vessel occlusion (LVO-AIS) and their dynamic changes with prognosis at 3 months.
Methods This retrospective study included patients with LVO-AIS who underwent EVT at the Second Affiliated Hospital of Soochow University between April 2017 and October 2021. Based on the mRS score at 3 months post-EVT, patients were divided into two groups: the favorable prognosis group (mRS score 0-2 points) and the poor prognosis group (mRS score 3-6 points). Data on age, sex, past history, and preoperative and postoperative 24 hours inflammatory response indicators [such as neutrophil (NEUT), neutrophil to lymphocyte ratio (NLR), and systemic inflammation response index (SIRI)] were collected for both groups. The association between inflammatory markers and poor prognosis, as well as the occurrence of symptomatic intracerebral hemorrhage (sICH) was explored through logistic regression analysis.
Results A total of 354 patients with LVO-AIS were included in this study, with 120 (33.90%) in the favorable prognosis group and 234 (66.10%) in the poor prognosis group. Multivariable logistic regression analysis revealed that NEUT (OR 1.24, 95%CI 1.12-1.37, P<0.001), NLR (OR 1.09, 95%CI 1.03-1.14, P=0.001), and SIRI (OR 1.14, 95%CI 1.05-1.23, P=0.002) levels 24 hours after EVT were independent risk factors for poor prognosis at 3 months. NEUT (OR 1.23, 95%CI 1.11-1.36, P<0.001), NLR (OR 1.06, 95%CI 1.03-1.10, P<0.001), SIRI (OR 1.08, 95%CI 1.02-1.14, P=0.005) levels 24 hours after EVT were independent risk factors for the occurrence of sICH in patients.
Conclusions The dynamic elevation of postoperative inflammatory markers NEUT, NLR, and SIRI levels may increase the risk of poor prognosis at 3 months after EVT in patients with LVO-AIS.

Key words: Ischemic stroke; Endovascular treatment; Prognosis; Inflammatory marker; Large vessel occlusion

中图分类号:

王辰涛, 戴婧, 李瑛姿, 温宇昕, 董理, 刘春风, 刘慧慧. 炎症标志物动态变化对急性缺血性卒中患者血管内治疗预后的影响[J]. 中国卒中杂志, 2025, 20(2): 163-170.

WANG Chentao, DAI Jing, LI Yingzi, WEN Yuxin, DONG Li, LIU Chunfeng, LIU Huihui. Effects of Dynamic Changes of Inflammatory Markers on Prognosis of Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment[J]. Chinese Journal of Stroke, 2025, 20(2): 163-170.

参考文献

[1] VAN HORN N，KNIEP H，LEISCHNER H，et al. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients[J]. J Neurointerv Surg，2021，13（1）：14-18.
[2] ZHAO W S，MA P J，ZHANG P，et al. Mechanical thrombectomy for acute ischemic stroke in octogenarians：a systematic review and meta-analysis[J/OL]. Front Neurol，2020，10：1355[2025-01-01]. https://doi.org/10.3389/fneur.2019.01355.
[3] YOO A J，ZAIDAT O O，CHAUDHRY Z A，et al. Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy[J]. Stroke，2014，45（3）：746-751.
[4] WANG Y G，YUAN X Y，KANG Y G，et al. Clinical predictors of prognosis in stroke patients after endovascular therapy[J/OL]. Sci Rep，2024，14（1）：667[2024-04-10]. https://doi.org/10.1038/s41598-024-51356-5.
[5] KIM J Y，PARK J，CHANG J Y，et al. Inflammation after ischemic stroke：the role of leukocytes and glial cells[J]. Exp Neurobiol，2016，25（5）：241-251.
[6] VIDALE S，CONSOLI A，ARNABOLDI M，et al. Postischemic inflammation in acute stroke[J]. J Clin Neurol，2017，13（1）：1-9.
[7] RUHNAU J，SCHULZE J，DRESSEL A，et al. Thrombosis，neuroinflammation，and poststroke infection：the multifaceted role of neutrophils in stroke[J/OL]. J Immunol Res，2017，2017：5140679[2025-01-01]. https://doi.org/10.1155/2017/5140679.
[8] JAYARAJ R L，AZIMULLAH S，BEIRAM R，et al. Neuroinflammation：friend and foe for ischemic stroke[J/OL]. J Neuroinflammation，2019，16（1）：142[2024-04-18]. https://doi.org/10.1186/s12974-019-1516-2.
[9] BOISSEAU W，DESILLES J P，FAHED R，et al. Neutrophil count predicts poor outcome despite recanalization after endovascular therapy[J/OL]. Neurology，2019，93（5）：e467-e475[2024-04-10]. https://doi.org/10.1212/WNL.0000000000007859.
[10] DIESTRO J D B，PARRA-FARINAS C，BALAS M，et al. Inflammatory biomarkers and intracranial hemorrhage after endovascular thrombectomy[J]. Can J Neurol Sci，2022，49（5）：644-650.
[11] WANG L，SONG Q H，WANG C Y，et al. Neutrophil to lymphocyte ratio predicts poor outcomes after acute ischemic stroke：a cohort study and systematic review[J/OL]. J Neurol Sci，2019，406：116445[2025-01-01]. https://doi.org/10.1016/j.jns.2019.116445.
[12] QI Q，ZHUANG L P，SHEN Y H，et al. A novel systemic inflammation response index（SIRI）for predicting the survival of patients with pancreatic cancer after chemotherapy[J]. Cancer，2016，122（14）：2158-2167.
[13] WEI L S，XIE H L，YAN P. Prognostic value of the systemic inflammation response index in human malignancy：a meta-analysis[J/OL]. Medicine（Baltimore），2020，99（50）：e23486[2025-01-01]. https://doi.org/10.1097/MD.0000000000023486.
[14] ZHANG Y H，XING Z K，ZHOU K C，et al. The predictive role of systemic inflammation response index（SIRI）in the prognosis of stroke patients[J/OL]. Clin Interv Aging，2021，16：1997-2007[2025-01-01]. https://doi.org/10.2147/CIA.S339221.
[15] YI H J，SUNG J H，LEE D H. Systemic inflammation response index and systemic immune-inflammation index are associated with clinical outcomes in patients treated with mechanical thrombectomy for large artery occlusion[J/OL]. World Neurosurg，2021，153：e282-e289[2024-04-10]. https://doi.org/10.1016/j.wneu.2021.06.113.
[16] 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，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南2018[J]. 中华神经科杂志，2018，51（9）：683-691.
Chinese Society of Neurology，Chinese Stroke Society，Neurovascular Intervention Group of Chinese Society of Neurology. Chinese guidelines for the endovascular treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，51（9）：683-691.
[17] ADAMS H P，Jr，BENDIXEN B H，KAPPELLE L J，et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial[J]. Stroke，1993，24（1）：35-41.
[18] BARBER P A，DEMCHUK A M，ZHANG J，et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy[J]. The Lancet，2000，355（9216）：1670-1674.
[19] PUETZ V，SYLAJA P N，COUTTS S B，et al. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion[J]. Stroke，2008，39（9）：2485-2490.
[20] LIU L P，DING J，LENG X Y，et al. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017[J]. Stroke Vasc Neurol，2018，3（3）：117-130.
[21] ZAIDAT O O，YOO A J，KHATRI P，et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke：a consensus statement[J]. Stroke，2013，44（9）：2650-2663.
[22] LARRUE V，VON KUMMER R R，MÜLLER A，et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator：a secondary analysis of the European-Australasian acute stroke study（ECASS Ⅱ）[J]. Stroke，2001，32（2）：438-441.
[23] GELDERBLOM M，LEYPOLDT F，STEINBACH K，et al. Temporal and spatial dynamics of cerebral immune cell accumulation in stroke[J]. Stroke，2009，40（5）：1849-1857.
[24] ZHANG P，XU P F，DUAN Z W，et al. Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion：insight from the PERSIST registry[J/OL]. J Neurointerv Surg，2023，15（e2）：e270-e276[2024-04-10]. https://doi.org/10.1136/jnis-2022-019437.
[25] SEMERANO A，LAREDO C，ZHAO Y，et al. Leukocytes，collateral circulation，and reperfusion in ischemic stroke patients treated with mechanical thrombectomy[J]. Stroke，2019，50（12）：3456-3464.
[26] DUAN Z H，WANG H M，WANG Z，et al. Neutrophil-lymphocyte ratio predicts functional and safety outcomes after endovascular treatment for acute ischemic stroke[J]. Cerebrovasc Dis，2018，45（5/6）：221-227.
[27] FENG Y，BAI X S，LI W，et al. Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy[J/OL]. Front Immunol，2022，13：963111[2025-01-01]. https://doi.org/10.3389/fimmu.2022.963111.
[28] KIM T J，PARK S H，KO S B. Dynamic change of neutrophil-to-lymphocyte ratio and symptomatic intracerebral hemorrhage after endovascular recanalization therapy[J/OL]. J Stroke Cerebrovasc Dis，2022，31（9）：106604[2024-04-18]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106604.
[29] LATTANZI S，NORATA D，DIVANI A A，et al. Systemic inflammatory response index and futile recanalization in patients with ischemic stroke undergoing endovascular treatment[J/OL]. Brain Sci，2021，11（9）：1164[2024-04-18]. https://doi.org/10.3390/brainsci11091164.
[30] 申慧鑫，孙蔚，武霄，等. 炎性反应相关指标对急性缺血性卒中患者血管内治疗临床预后的影响[J]. 中国脑血管病杂志，2023，20（6）：382-391.
SHEN H X，SUN W，WU X，et al. Influence of inflammatory markers on predicting clinical prognosis in patients with acute ischemic stroke after endovascular treatment[J]. Chin J Cerebrovasc Dis，2023，20（6）：382-391.
[31] CHAMORRO Á，MEISEL A，PLANAS A M，et al. The immunology of acute stroke[J]. Nat Rev Neurol，2012，8（7）：401-410.
[32] JAIPERSAD A S，LIP G Y，SILVERMAN S，et al. The role of monocytes in angiogenesis and atherosclerosis[J]. J Am Coll Cardiol，2014，63（1）：1-11.