摘要
目的探讨入院时中性粒细胞/淋巴细胞比值(neutrophils to lymphocyte ratio,NLR)、血管内机械取栓术后3~7 d NLR和围术期NLR变化与接受取栓治疗的前循环大血管闭塞性急性缺血性卒中患者临床预后关系。方法回顾性分析2018年1月至2021年6月在郑州大学人民医院接受血管内机械取栓治疗的前循环大血管闭塞性急性缺血性卒中患者的基线数据、临床表现和手术相关指标,将入院时NLR定义为NLR1,术后3~7 d NLR定义为NLR2,NLR2-NLR1定义为围术期NLR变化。根据术后90 d改良Rankin量表(modified Rankin scale,mRS)评分将患者分为临床预后良好组和临床预后不良组,将单因素分析P<0.05的因素纳入Logistics多因素回归分析中,探讨NLR1、NLR2及围术期NLR变化与临床预后的关系。结果本研究共纳入332例患者,其中268例(80.7%)患者实现成功再灌注,术后90 d随访时有147例(44.3%)患者临床预后良好。单因素分析显示,NLR2较低和围术期NLR变化较低与临床预后、成功再灌注、症状性颅内出血和术后90 d随访时死亡率有统计学意义(P<0.05);进一步多变量Logistic分析表明,年龄(OR:1.063,95%CI:1.034~1.092,P<0.001)、侧支循环(OR:0.454,95%CI:0.249~0.829,P=0.010)、首次通过再灌注(OR:0.318,95%CI:0.172~0.589,P<0.001)、围术期NLR变化(OR:2.474,95%CI:1.964~3.117,P<0.001)是临床预后的独立预测因素。受试者工作特征曲线分析发现,围术期NLR变化截断值为3.42时,预测临床预后敏感性和特异性分别为81.1%、74.1%。结论取栓术后3~7 d NLR和围术期NLR变化与成功再灌注、症状性颅内出血和死亡率相关,围术期NLR变化是临床预后的独立预测因子。
Objective To investigate the relationship between the clinical prognosis of acute ischemic stroke patients with anterior circulation large vessel occlusion treated with thrombectomy and neutrophils to lymphocyte ratio(NLR)at admission,NLR 3-7 days after operation and the changes of perioperative NLR.MethodsThis study retrospectively analyze the patients with anterior circulation large vessel occlusive acute ischemic stroke who underwent thrombectomy in Zhengzhou University People's Hospital from January 2018 to June 2021.The baseline data,clinical manifestations and operation related indexes were collected.The patients were divided into good clinical prognosis group and poor clinical prognosis group according to the modified Rankin scale score 90 days after operation,NLR at admission was defined as NLR1,NLR at 3-7 days after operation was defined as NLR2,and NLR2-NLR1 was defined as the change of perioperative NLR.The factors withP<0.05 in univariate analysis were included in logistic multivariate regression analysis to explore the relationship between NLR1,NLR2 and perioperative NLR and clinical prognosis,and to explore whether these indicators can predict the clinical prognosis.ResultsA total of 332 patients with anterior circulation large vessel occlusive AIS treated with MT were included in this study,of which 268(80.7%)achieved successful reperfusion.At the 90 day follow-up,147(44.3%)patients had a good clinical prognosis.Univariate analysis showed that lower NLR2 and smaller perioperative NLR changes were significantly associated with clinical prognosis,successful reperfusion,symptomatic intracranial hemorrhage(sICH)and mortality at 90 day follow-up(P<0.05).Multivariate logistic analysis showed that age(OR:1.063,95%CI:1.034-1.092,P<0.001),collateral circulation(OR:0.454,95%CI:0.249-0.829,P=0.01),first reperfusion(OR:0.318,95%CI:0.172-0.589,P<0.001)and perioperative NLR changes(OR:2.474,95%CI:1.964-3.117,P<0.001)were independent predictors of clinical prognosis.Receiver Operating Characteristic Curve showed
作者
林枫
张鸿运
贺迎坤
李天晓
Feng Lin;Hongyun Zhang;Yingkun He;Tianxiao Li(Cerebrovascular Department of Interventional Center,Zhengzhou University People's Hospital,Neurosurgery Department of Stroke Center,Henan Provincial People's Hospital,Henan Provincial Neurointerventional Engineering Research Center,Henan International Joint Laboratory of Cerebrovascular Disease,Henan Engineering Research Center of Cerebrovascular Intervention Innovation,Henan International Joint Laboratory of cerebrovascular,Henan Zheng Zhou 450003,China)
出处
《中华介入放射学电子杂志》
2022年第4期396-403,共8页
Chinese Journal of Interventional Radiology：electronic edition
基金
国家脑卒中高危人群干预适宜技术研究及推广项目(GN-2018R0007)
河南省医学科技公关计划省部共建项目(SBGJ2018063)
关键词
前循环大血管闭塞
急性缺血性卒中
机械取栓
中性粒细胞与淋巴细胞比值
临床预后
Anterior circulation large vessel occlusion
Acute ischemic stroke
Mechanical thrombectomy
Neutrophil to Lymphocyte Ratio
Clinical prognosis
