Value of Neutrophil to Lymphocyte Ratio and Derived Neutrophil to Lymphocyte Ratio in Prediction of Hemorrhagic Transformation In Acute Ischemic Stroke with Large-artery Atherosclerosis
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摘要:
目的 探讨外周血粒淋比（NLR）和衍生粒淋比（dNLR）对大动脉粥样硬化型脑梗死出血转化（acute ischemic stroke with large-artery atherosclerotic，AIS-LAA）患者出血转化（hemorrhagic transformation，HT）的预测价值。 方法 选取2020年10月至2021年2月首都医科大学附属北京友谊医院神经内科住院的AIS-LAA患者151例，根据HT发生的情况分为HT组19例和non-HT组132例，收集临床资料及实验室检查指标，利用多因素Logistic回归分析及绘制ROC曲线评价NLR、dNLR对AIS-LAA患者HT的预测价值。 结果 （1）HT组患者入院时NHISS评分、入院时收缩压高于non-HT组，HT组接受溶栓治疗的患者多于non-HT组，HT组淋巴细胞计数、NLR及dNLR高于non-HT组（P < 0.05）；（2）多因素Logistic回归分析结果提示NLR[Adjusted OR（aOR）=1,441，95% CI （1.154～1.798），P = 0.001]、dNLR[aOR=1.505，95% CI （（1.163～2.165），P < 0.001]是AIS-LAA患者HT的独立影响因素；（3）ROC曲线提示，NLR预测AIS-LAA患者HT的AUC为0.71 [95% CI （0.63～0.78），P = 0.004]，NLR的cut-off值为4.61，灵敏度63.16%，特异度80.3%；dNLR预测AIS-LAA患者HT的AUC为0.75 [95% CI （0.67～0.82），P < 0.001]，dNLR的cut-off值为2.78，灵敏度63.16%，特异度83.3%。 结论 NLR和dNLR可能是AIS-LAA患者HT的独立影响因素，其中dNLR对AIS-LAA患者HT的预测价值更高。 Abstract:Objective To investigate the value of NLR and dNLR in prediction of HT in patients with AIS-LAA. Methods A retrospective study was conducted to analyze the clinical data of 151 patients with AIS-LAA, Department of Neurology, Beijing Friendship Hospital, from October 2020 to February 2021. They were divided into HT group （n = 19） and non-HT group （n = 132） according to the incidence of HT. General information and laboratory examination results were collected. The influencing factors of HT in patients with AIS were analyzed by multivariate Logistic regression analysis, ROC curve was drawn to analyze the predictive value of NLR and dNLR on HT in patients with AIS-LAA. Results （1） NIHSS and systolic blood pressure on admission in HT group were statistically significantly higher than that in non-HT group, the number of thrombolysis in HT group was statistically significantly higher than those in non-HT （P < 0.05）; （2） Multivariate Logistic regression analysis results showed that NLR [aOR = 1,441, 95% CI （1.154-1.798）, P = 0.001] and dNLR [aOR = 1.505, 95% CI （1.163-2.165）, P < 0.001] were independent influencing factors of HT in patients with AIS-LAA. （3） ROC curves demonstrated that the optimal cutoff value of dNLR for HT was 2.78 （sensitivity 83.3%, specificity 63.16%）, the area under the curve （AUC） value is 0.75 [95% CI （0.67-0.82）, P < 0.001]. For NLR, the optimal cutoff value was 4.61 （sensitivity 80.3%, specificity 63.16%）, the AUC value 0.71 [95% CI （0.63-0.78）, P = 0.004]. Conclusion NLR and dNLR are probably independent influencing factors of HT in patients with AIS-LAA, dNLR has relatively high value in prediction of HT in patients with AIS-LAA. -
图 1 NLR、dNLR预测大动脉粥样硬化所致脑梗死患者出血转化的ROC曲线
Figure 1. Predictive value of NLR and dNLR for HT in AIS-LAA
表 1 2组患者基线资料和实验室检查数据[（
$\bar x \pm s $ ）/n（%）/[M（P25，P75）]Table 1. Baseline characteristics and laboratory examination data in 2 groups of patients [（
$\bar x \pm s $ ）/n（%）/[M（P25，P75）]基线信息 总例数（n = 151） 非 HT组（n = 132） HT组（n = 19） t/χ2/z P 年龄（岁） 64±10.8 64±10.4 65±11.2 0.163 0.684 男性 107（72.6） 93（70.5） 14（73.7） 0.084 0.774 高血压病史 81（53.6） 70（53.0） 11（57.9） 0.158 0.699 糖尿病病史 61（40.4） 53（40.2） 8（42.1） 0.026 0.876 高脂血症病史 17（11.3） 14（10.6） 3（15.8） 0.447 0.507 脑卒中病史 12（7.9） 10（7.6） 2（10.5） 0.198 0.657 吸烟史 55（36.4） 47（35.6） 8（42.1） 0.303 0.582 饮酒史 89（58.9） 77（58.3） 12（63.2） 0.160 0.689 入院时NIHSS评分，
中位数4[2，9] 4[2，7] 7[4，11] 4.768 0.022* 入院时收缩压（mmHg） 140.5±16.5 138.6±16.2 153.4±15.7 8.833 0.003* 抗血小板治疗 149（98.7） 130（98.5） 19（100） 0.292 0.589 抗凝治疗 6（4.0） 5（3.8） 2（10.6） 1.706 0.192 溶栓治疗 7（4.6） 4（3.0） 3（15.8） 6.100 0.013* 机制 动脉到动脉栓塞 73（48.3） 63（47.7） 10（52.6） 0.160 0.689 原位血栓形成 40（26.5） 36（27.3） 4（21.1） 0.330 0.566 灌注不足 12（7.9） 10（7.6） 2（10.5） 0.198 0.657 穿支动脉粥样斑块 26（17.2） 23（17.4） 3（15.8） 0.031 0.860 实验室检查结果 白细胞 （109/L） 6.93[5.64，8.33] 6.81[5.36，7.89] 8.3[5.22，10.47] 3.874 0.052 中性粒细胞（109/L） 4.67[3.54，6.66] 4.47[3.54，6.13] 6.98[3.21，9.30] 3.531 0.058 淋巴细胞（109/L） 1.73[1.39，2.07] 1.75[1.53，2.11] 1.38[1.04，1.49] 8.826 0.003* NLR 2.57[1.88，4.46] 2.49[1.69，3.82] 4.91[2.10，7.89] 10.218 < 0.001* dNLR 1.91[1.18，2.90] 1.75[1.13，2.63] 3.63[1.78，5.48] 10.872 < 0.001* *P < 0.05。 
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表 2 多因素Logistic回归分析NLR、dNLR和大动脉粥样硬化所致脑梗死后出血转化的相关性
Table 2. Multivariate analysis for the association between NLR,dNLR and HT in AIS-LAA
检测变量§ β Wald Adjusted OR（95% CI） P NLR 1.365 10.444 1,441（1.154-1.798） 0.001* dNLR 1.938 12.405 1.505（1.163-2.165） < 0.001* §多因素Logistic回归分析校正了入院时收缩压、入院时NIHSS评分、溶栓治疗。*P < 0.05。
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表 3 NLR和dNLR对大动脉粥样硬化所致脑梗死出血转化的预测价值
Table 3. Comparison of predictive power between dNLR and NLR
检测变量 Cut-off值 特异性 敏感度 曲线下面积 （95%CI） z P NLR 4.61 80.3% 63.16% 0.71（0.63-0.78） 2.915 0.004* dNLR 2.78 83.3% 63.16% 0.75（0.67-0.82） 4.423 < 0.001* *P < 0.05。
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