血小板/中性粒细胞比值和超氧化物歧化酶对急性缺血性脑卒中的诊疗价值

目的探究血小板/中性粒细胞比值（PNR）和超氧化物歧化酶（SOD）在急性缺血性脑卒中（AIS）患者病情早期评估和预后效果预判中的临床意义。 方法选取2020年6月至2021年6月期间于新疆乌鲁木齐市友谊医院脑卒中心住院接受阿替普酶（rt-PA）静脉溶栓治疗的AIS患者49例，收集相关临床资料。根据美国国立卫生研究院卒中量表（NIHSS）评分将患者分为轻度组、中重度组，通过检测外周血PNR、SOD实验指标，统计分析溶栓前PNR、SOD与AIS患者NIHSS评分之间的相关性从而评估患者病情。采用ROC曲线确定接受rt-PA静脉溶栓后24 h患者PNR、SOD水平对不同AIS患者接受rt-PA溶栓效果良好结局的预测能力。通过并联、串联试验原则分析溶栓后PNR、SOD联合试验诊断AIS预后良好的灵敏度和特异度。 结果患者入院NIHSS评分与溶栓前PNR指标呈正相关（R=0.630，P＜0.001），和SOD指标呈负相关（R=-0.281，P＜0.001）；轻度AIS组PNR指标水平低于中重度AIS组，SOD指标水平高于中重度AIS组，差异具有统计学意义（P＜0.001，P＜0.01）。通过评估溶栓后PNR和SOD对AIS患者短期预后的ROC曲线，发现PNR的良好结局预测能力有一定准确性（AUC=0.833，95% CI= 0.712~0.955），cut-off值为30.705%，灵敏度为0.867，特异度为0.789，约登指数为1.656；SOD的良好结局预测能力有一定准确性（AUC=0.723，95% CI=0.555~0.890），cut-off值为195.850 U/ml，灵敏度为0.833，特异度为0.579，约登指数为1.512。PNR与SOD并联试验的敏感度提高为93.3%；串联试验的特异度提高为84.2%。 结论PNR、SOD指标能有效、客观评估AIS患者病情严重程度。溶栓后PNR、SOD指标能为AIS患者4.5 h内的rt-PA静脉溶栓良好预后提供具有一定敏感度、特异度的早期血液指标。

The value of platelet/neutrophil ratio and superoxide dismutase in the diagnosis and treatment of acute ischemic stroke

ObjectiveTo explore the clinical significance of platelet/neutrophil ratio (PNR) and superoxide dismutase (SOD) detection in early assessment and prognosis of patients with acute ischemic stroke (AIS). MethodsA total of 49 patients with acute ischemic stroke who received intravenous thrombolytic therapy with alteplase (rt-PA) in Department of Neurology of Urumqi Friendship Hospital from June 2020 to June 2021 were selected to collecte the relevant clinical data. According to the National Institutes of Health Stroke Scale (NIHSS) score, the patients were divided into mild group and moderate and severe group. By testing PNR and SOD experimental indicators , The correlation between PNR、SOD and AIS patient NIHSS score before thrombolytic was statistically analyzed to evaluate the patient's condition. The ROC curve was used to determine the predictive ability of PNR and SOD levels 24 hours after intravenous thrombolysis with alteplase (rt-PA) to predict the good outcome of rt-PA in patients with different AIS. ResultsThe NIHSS score was positively correlated with PNR index before thrombolysis (R=0.630, P＜0.001) and negatively correlated with SOD index (R=-0.281, P＜0.001). The level of PNR index in moderate AIS group was lower than that in severe AIS group, and the level of SOD index was higher than that in severe AIS group (P＜0.001, P＜0.01). By evaluating the ROC curve of SOD, PNR and short-term prognosis of AIS patients after thrombolysis, it was found that PNR had certain accuracy in predicting good outcome (AUC=0.833, 95%CI=0.712-0.955), the cut-off value was 30.705%, the sensitivity was 0.867, the specificity was 0.789, and the Youden index was 1.656. The predictive ability of SOD was accurate (AUC=0.723, 95%CI=0.555-0.890), and the cut-off value was 195.850 U/ml. The sensitivity, specificity and Youden index were 0.833, 0.579 and 1.512, respectively. ConclusionsPNR and SOD indexes can effectively and objectively evaluate the severity of AIS patients. PNR and SOD indexes after thrombolytic therapy can provide early blood indicators with certain sensitivity and specificity for the good prognosis of RT-PA intravenous thrombolytic therapy in AIS patients within 4.5 hours.