摘要
目的分析术前中性粒细胞/淋巴细胞比值(NLR)及纤维蛋白原/白蛋白比值(FAR)对急性前循环大血管闭塞性脑梗死(ALVOS)早期血管内治疗(EVT)后出现恶性脑水肿(MBE)的影响。方法回顾性连续纳入2018-08—2022-05就诊于马鞍山市人民医院神经内科早期血管内治疗后血管成功再通的前循环ALVOS患者,分析临床资料以及预后情况,比较恶性水肿组与非恶性水肿组基线资料及术前外周血结果,采用二分类多因素Logistic回归方法分析EVT再通后恶性脑水肿的独立危险因素,使用ROC曲线对术前NLR、FAR及NLR联合FAR预测ALVOS患者血管再通后出现恶性水肿的敏感性和特异性。结果NLR和FAR的AUC分别为0.784和0.739。NLR的灵敏度和特异度分别为82.61%和74.36%,FAR的灵敏度和特异度分别为65.22%和74.36%。当NLR和FAR两个指标进行联合预测时,AUC为0.816,大于NLR和FAR单独预测时的AUC,联合预测的灵敏度和特异度分别为69.57%和87.18%。多因素Logistic回归分析显示,有卒中史的患者出现恶性水肿概率高于无卒中史者(OR=184.461,95%CI:2.565~13263.614);房颤患者出现恶性水肿率高于无房颤患者(OR=435.610,95%CI:4.181~45388.026);入院时NIHSS评分越高,患者出现恶性水肿的概率越高(OR=2.239,95%CI:1.379~7.607);NLR越大,患者出现恶性水肿的概率越大(OR=3.481,95%CI:1.264~9.585)。结论术前NLR和FAR增高可用于预测急性前循环血管闭塞患者取栓再通后恶性脑水肿,当两个指标联合预测时效果更佳。卒中史、房颤、高NIHSS评分、高NLR为患者出现恶性水肿的危险因素。
Objective To analyze the influence of preoperative neutrophil/lymphocyte ratio(NLR)and fibrinogen/albumin ratio(FAR)on the occurrence of malignant brain edema(MBE)after early endovascular treatment(EVT)for acute anterior circulation large vessel occlusive cerebral infarction(ALVOS).Methods Pa⁃tients with anterior circulation ALVOS who were diagnosed with successful recanalization after early endovascular treatment in the Department of Neurology of Ma’anshan People’s Hospital from August 2018 to May 2022 were retrospectively included.Their clinical data and prognosis were retrospectively analyzed.The baseline data and preoperative peripheral blood results of malignant edema group and non-malignant edema group were mainly com⁃pared.The independent risk factors of malignant cerebral edema after EVT recanalization were analyzed by binary multivariate Logistic regression analysis method,ROC curve was used to evaluate the sensitivity and specificity of preoperative NLR,FAR and NLR combined with FAR in predicting malignant edema after vascular recanalization in ALVOS patients.Results NLR and FAR AUC are 0.784 and 0.739 respectively.NLR sensitivity and speciality rate were 82.61%and 74.36%respectively,the sensi⁃tivity of FAR and specific degrees were 65.22%and 74.36%,respectively.For joint when the NLR and FAR two indicators,AUC is 0.816,and is greater than the NLR and FAR single prediction of AUC.Combination forecast sensitivity and speciality rate were 69.57%and 87.18%,respectively.Multiariable Logistic regression analysis,has a history of stroke in patients with malignant edema probability is higher than in patients with no history of stroke(OR=184.461,95%CI 2.565-13263.614).Probability higher than that of patients with atrial fibrillation patients with atrial fibrillation(OR=435.610,95%CI:4.181-45388.026).On the NIHSS scale score,the greater the patients with malignant edema,the higher the probability of the(OR=2.239,95%CI:1.379-7.607).NLR is larger,the greater the probability of patients with malignant ede
作者
项良旭
李美英
凤兆海
徐竞
郑颖炜
李志德
XIANG Liangxu;LI Meiying;FENG Zhaohai;XU Jing;ZHENG Yingwei;LI Zhide(Maanshan Peoples Hospital,Maanshan 243000,China)
出处
《中国实用神经疾病杂志》
2022年第9期1074-1080,共7页
Chinese Journal of Practical Nervous Diseases
基金
马鞍山市科技局项目(编号:YL-2019-19)。
