中性粒细胞与淋巴细胞比值对急性脑梗死患者预后的预测价值

目的探讨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2014年1月至2015年12月郑州大学第五附属医院神经内科住院的急性脑梗死患者307例,其中女80例,男227例。根据改良Rankin量表评分标准,分为预后良好组(195例)和预后不良组(112例)。记录入院时年龄、性别、既往病史、美国国立卫生研究院卒中量表(NIHSS)评分等资料,根据入院中性粒细胞计数与淋巴细胞计数计算出NLR值。采用Logistics回归分析急性脑梗死预后不良的影响因素,采用受试者工作特征(ROC)曲线评价入院时NLR水平对急性脑梗死患者预后不良的预测作用。结果 (1)与预后良好组比较,预后不良组患者年龄、复发性脑梗死发生率、入院时NIHSS评分、入院NLR水平均较高,组间差异均有统计学意义[(69±12)岁比(62±14)岁,25.0%(28/112)比14.4%(28/195),5.00(3.00,9.00)分比3.00(1.75,5.00)分,3.66(2.62,7.91)比2.47(1.94,3.40),均P0.05],其余基线资料和临床特征的组间差异均无统计学意义(均P0.05)。(2)多因素Logistics回归分析结果显示,年龄、入院NIHSS评分及入院时NLR水平的升高,是预后不良的独立危险因素(OR值分别为1.030,1.148,1.427,95%CI分别为1.007~1.053,1.059~1.246,1.247~1.634,均P0.05)。(3)入院时NLR水平对急性脑梗死患者预后不良的诊断界值为2.84,其敏感度为69.6%,特异度为64.6%。结论入院时NLR水平增高对评估急性脑梗死患者预后不良具有一定的参考价值。

Neutrophil and lymphocyte ratios for the predictive analysis of the prognosis in patients with acute cerebral infarction

Objective To investigate the predictive value of neutrophil and lymphocyte ratios (NLR)for the prognosis in patients with acute cerebral infarction. Methods From January 2014 to December 2015,307 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,the Fifth Affiliated Hospital of Zhengzhou University were enrolled retrospectively,including 80 females and 227 males. They were divided into ether a good prognosis group (n = 195)or a poor prognosis group (n = 112)according to the scoring criteria of the modified Rankin scale (mRS). The age,gender, past medical history,National Institutes of Health stroke scale (NIHSS)score were documented on admission. The NLR values were calculated according to the neutrophil and lymphocyte counts on admission. Logistic regression analysis was used to analyze the influencing factors of poor prognosis of acute cerebral infarction. The receiver operating characteristic curve (ROC)was used to evaluate the predictive effect of the NLR level on patients with acute cerebral infarction on admission. Results (1)Compared with the good prognosis group,the age,incidence of recurrent cerebral infarction,NIHSS score on admission, NLR levels on admission in the poor prognosis group were higher. There were significant differences between groups (69 ± 12 years vs. 62 ± 14 years,25. 0% [28 / 112]vs. 14. 4% [28 / 195],5. 00 [3. 00, 9. 00]vs. 3. 00 [1. 75,5. 00],and 3. 66 [2. 62,7. 91]vs. 2. 47 [1. 94,3. 40];all P < 0. 05). There were no significant differences in other baseline data and clinical characteristics between the groups (all P >0. 05). (2)Multivariate logistic regression analysis showed that the increase of the age,NLR level on admission,and increased NIHSS score on admission,were independent risk factor for poor prognosis (OR 1. 030,1. 148,and 1. 427,respectively,95% CI were 1. 007 -1. 053,1. 059 -1. 246,and 1. 247 -1. 634, respectively;all P < 0. 05). (3)The diagnostic cut-off value of the NLR level on admission for the poor prognosis in patients with acute cerebral infarction was 2. 84. Its sensitivity was 69. 6% and specificity was 64. 6% . Conclusion The increase of the NLR level on admission had certain reference function on the poor prognosis in patients with acute ischemic stroke.