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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的预测价值研究

杨毅 张拥波

杨毅, 张拥波. 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的预测价值研究[J]. 昆明医科大学学报, 2021, 42(11): 33-37. doi: 10.12259/j.issn.2095-610X.S20211106
引用本文: 杨毅, 张拥波. 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的预测价值研究[J]. 昆明医科大学学报, 2021, 42(11): 33-37. doi: 10.12259/j.issn.2095-610X.S20211106
Yi YANG, Yong-bo ZHANG. 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[J]. Journal of Kunming Medical University, 2021, 42(11): 33-37. doi: 10.12259/j.issn.2095-610X.S20211106
Citation: Yi YANG, Yong-bo ZHANG. 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[J]. Journal of Kunming Medical University, 2021, 42(11): 33-37. doi: 10.12259/j.issn.2095-610X.S20211106

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的预测价值研究

doi: 10.12259/j.issn.2095-610X.S20211106
基金项目: 国家自然科学基金资助项目(81671191)
详细信息
    作者简介:

    杨毅(1985~),女,山东济南人,医学博士,主治医师,主要从事脑血管病的相关临床及基础研究工作

    通讯作者:

    张拥波,E-mail:yongbozhang@ccmu.edu.cn

  • 中图分类号: R743.32

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

  • 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。
  • 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/zP
    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。
    下载: 导出CSV

    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§βWaldAdjusted OR(95% CIP
    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。
    下载: 导出CSV

    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)zP
    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。
    下载: 导出CSV
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  • 收稿日期:  2021-09-05
  • 网络出版日期:  2021-11-15
  • 刊出日期:  2021-11-30

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