PLR与NLR对急性脑梗死患者预后的预测价值

目的 血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）对急性脑梗死患者预后的预测价值。方法 回顾性连续纳入2016年1月~2016年12月于笔者医院神经内科住院的急性脑梗死患者507例，依照改良Rankin量表（mRS）对所有患者进行神经功能评分并分为预后良好组318例（≤ 2分），预后不良组189例（>2分）。比较两组基线资料，根据入院时血小板计数、中性粒细胞计数与淋巴细胞计数计算NLR、PLR值。采用多因素Logistic回归分析急性脑梗死患者预后不良影响因素，采用ROC曲线评价入院时PLR、NLR水平对急性脑梗死患者预后的预测作用。结果 预后不良组年龄、空腹血糖、NEUT计数、PLT计数、入院时NLR水平、入院时PLR水平、入院NIHSS评分、脑梗死病史率均显著高于预后良好组，组间比较差异有统计学意义（P<0.05）；预后不良组尿酸、LYM计数均显著低于预后良好组，组间比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，尿酸水平升高是AIS患者预后良好的独立保护因素；年龄、NEUT计数、PLT计数、入院NIHSS评分、入院时高水平NLR和PLR是AIS患者发生预后不良的独立危险因素。入院时PLR、NLR水平对急性脑梗死患者预后不良的诊断界值分别为137.47、3.92，敏感度分别为69.8%、64%，特异性分别为70.8%、82.7%，PLR和NLR联合预测敏感度为74.1%，特异性为75.2%。结论 入院时PLR、NLR水平对急性脑梗死患者预后有良好的预测价值，高PLR、NLR水平提示预后不良。

Predictive Value of Platelet to Lymphocyte Ratio and Neutrophils to Lymphocyte Ratio on the Prognosis in Patients with Acute Ischemic Stroke

Objective To investigate the predictive value of platelet to lymphocyte ratio and neutrophils to lymphocyte ratio on the prognosis in patients with acute ischemic stroke.Methods From January 2016 to December 2016, a total of 507 consecutive patients admitted to our Department of Neurology, were recruited retrospectively. The patients were divided into good prognosis group(n=318) and poor prognosis group(n=189) according to the scoring criteria of the modifiled Rankin scale(mRS). The differences of the baseline characteristics were compared between 2 groups.The PLR and NLR values were calculated according to platelet, neutrophils and lymphocyte counts on admission.Multivariate logistic regression analysis was used to analyze the factors of poor prognosis of acute ischemic stroke.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of PLR and NLR level on patients with acute ischemic stroke.Results Age,fasting plasma glucose, neutrophils counts, platelet counts,NLR level,PLR level,NIHSS score on admission and recurrent ischemic stroke in poor prognosis group were significantly much higher than in good prognosis group, (all P<0.05)whereas serum uric acid level and lymphocyte counts were much lower(all P <0.05).There were significant differences between groups.The results of multivariate logistic regression analysis showed that the increase of serum uric acid was independently associated with favorable outcome, whereas the increase of age, neutrophils counts, platelet counts,increased NHISS score on admission,NLR and PLR level were independent risk factors for poor prognosis.The optimal critical value of PLR and NLR level on admission for the poor prognosis were 137.47 and 3.92.Their sensitivity were 69.8% and 64%,while specificity were 70.8% and 82.7%.Their joint prediction in sensitivity and specificity were 74.1% and 75.2%.Conclusion PLR and NLR level on admission possesse good predictive value of prognosis for the patients with acute ischemic stroke.High PLR and NLR level are associated with poor outcome.