单核细胞与高密度脂蛋白胆固醇比值与急性缺血性卒中静脉溶栓短期预后的关系

目的 探讨单核细胞与HDL-C比值（monocyte-to-HDL cholesterol ratio，MHR）与急性缺血性卒中 （acute ischemic stroke，AIS）静脉溶栓短期预后的关系。 方法 回顾性纳入2015年1月1日-2017年12月1日在郑州大学第一附属医院神经内科急诊接受静脉 溶栓治疗的AIS患者。患者预后通过90 d mRS来评估，良好预后定义为mRS评分≤2分。采用多因素 Logistic回归分析MHR及其他基线资料与90 d预后的关系，应用ROC曲线评价MHR对预后的预测价值。 结果 共纳入281例患者，平均年龄59.54±12.49岁，男性183例（65.1%），良好预后223例（79.4%）。 多因素Logistic回归分析显示，高龄（OR 1.03，95%CI 1.01～1.06，P =0.013）、溶栓前NI HSS评分高（OR 1.31，95%CI 1.17～1.44，P＜0.001）和高MHR（OR 2.39，95%CI 1.10～5.25，P =0.028）是AIS静脉溶栓患 者90 d不良预后的独立影响因素。亚组分析显示，高MHR（OR 5.15，95%CI 1.28～20.77，P =0.021）是 大动脉粥样硬化型AIS静脉溶栓90 d不良预后的独立影响因素。ROC曲线分析显示，MHR预测预后不良 的最佳界值为0.48，其敏感度和特异度分别为79.41%和58.33%。 结论 MHR是AIS尤其大动脉粥样硬化型静脉溶栓短期预后的独立影响因素。

Relationship between Monocyte-to-HDL Cholesterol Ratio and Short-term Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Objective To investigate the relationship between monocyte-to-HDL cholesterol ratio (MHR) and
short-term prognosis in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis.
Methods A retrospective analysis of consecutive AIS patients treated with intravenous thrombolysis
in Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January
2015 to December 2017 was undertaken. Functional outcome at 90 days was evaluated by the mRS.
Good outcome was defined as a mRS score of 0-2. Multivariate logistic regression analysis was
conducted to evaluate the relationship between MHR and 90-day outcome. The ROC curve analysis
was performed to evaluate the predictive value.
Results A total of 281 patients were included, with an average age of 59.54±12.49 years and 183
males (65.1%). 223 cases (79.4%) had good prognosis. Multivariate analysis showed that higher
age (OR 1.03, 95%CI 1.01-1.06, P=0.013), baseline NIHSS score (OR 1.31, 95%CI 1.17-1.44,
P<0.001) and MHR (OR 2.39, 95%CI 1.10-5.25, P=0.028) were independent predictors for 90-day
poor prognosis. Subgroup analysis showed that high MHR (OR 5.15, 95%CI 1.28-20.77, P=0.021)
was an independent predictor for 90-day poor prognosis in patients with large atherosclerotic stroke.
ROC curve analysis showed that the optimal cut-off point of MHR was 0.48, and the sensitivity and
specificity of predicting short-term poor prognosis were 79.41% and 58.33%.
Conclusions MHR was an independent predictor for short-term prognosis after venousthrombolysis in AIS patients, especially in patients with large atherosclerotic stroke.