中性粒细胞与淋巴细胞比值对急性缺血性卒中患者血管内治疗后症状性颅内出血的预测价值

doi:10.19854/j.cnki.1008-2425.2023.06.0008

摘要/Abstract

摘要： 目的评估中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)在预测急性缺血性卒中(Acute ischaemic stroke,AIS)患者血管内治疗(Endovascular therapy,EVT)后发生症状性颅内出血(symptomatic intracranial hemorrhage,sICH)的价值。方法回顾性分析中国科学技术大学附属第一医院2020年11月至2023年5月期间收治的182例行血管内治疗的AIS患者的临床资料,根据是否发生症状性出血(sICH)进行分组。比较两组间临床资料的差异,评估EVT治疗前后NLR(Pre-EVT NLR、Post-EVT NLR)对AIS患者EVT后发生sICH的预测价值。结果 182例行血管内治疗AIS患者中,46例发生了sICH。多因素Logistic回归分析提示,较高的Pre-EVT NLR、Post-EVT NLR是AIS患者EVT后发生sICH的独立危险因素(Pre-EVT NLR:OR=1.146,95%CI:1.052-1.250,P=0.002;Post-EVT NLR:OR=1.128,95%CI:1.030~1.236,P=0.009)。Pre-EVT NLR、Post-EVT NLR预测AIS患者EVT后发生sICH的曲线下面积(AUC)分别为0.683(95%CI:0.586~0.781,P＜0.001)和0.619(95%CI:0.523~0.715,P=0.016)。结论 Pre-EVT NLR、Post-EVT NLR均是AIS患者EVT后发生sICH的预测因子。

关键词: 中性粒细胞与淋巴细胞比值, 急性缺血性卒中, 症状性颅内出血, 血管内治疗, 预测因子

Abstract: Objective To assess the value of neutrophil-to-lymphocyte ratio (NLR) in predicting the occurrence of symptomatic haemorrhage after endovascular treatment in patients with acute ischaemic stroke (AIS).Methods The clinical data of 182 endovascularly treated AIS patients admitted to the tertiary stroke centre of the First Affiliated Hospital of the University of Science and Technology of China between November 2020 and May 2023 were retrospectively analysed and grouped according to the presence or absence of symptomatic cerebral hemorrhage (sICH).The differences in clinical data between the two groups were compared to assess the predictive value of NLR before and after EVT treatment (Pre-EVT NLR,Post-EVT NLR) for the occurrence of sICH after EVT in AIS patients.Results Among 182 patients with endovascularly treated AIS,46 developed sICH.Multifactorial logistic regression analysis suggested that higher Pre-EVT NLR and Post-EVT NLR were independent risk factors for the development of sICH after EVT in patients with AIS (Pre-EVT NLR:OR=1.146,95%CI:1.052~1.250,P=0.002;Post-EVT NLR:OR=1.128,95%CI:1.030~1.236,P=0.009).The area under the curve (AUC) for Pre-EVT NLR and Post-EVT NLR predicting the development of sICH after EVT in AIS patients was 0.683 (95%CI:0.586~0.781,P＜0.001) and 0.619 (95%CI:0.523~0.715,P=0.016),respectively.Conclusion Pre-EVT NLR and Post-EVT NLR were both predictors of sICH after EVT in AIS patients.

Key words: Neutrophil-to-lymphocyte ratio, Acute ischaemic stroke, Symptomatic intracranial hemorrhage, Endovascular therapy, Predictor

中图分类号:

R743.34

汪影, 高智, 汤睿, 杜敏, 周敏. 中性粒细胞与淋巴细胞比值对急性缺血性卒中患者血管内治疗后症状性颅内出血的预测价值[J]. 立体定向和功能性神经外科杂志, 2023, 36(6): 359-364.

Wang Ying, Gao Zhi, Tang Rui, et al. Predictive value of neutrophil-to-lymphocyte ratio for symptomatic intracranial haemorrhage after endovascular treatment in patients with acute ischaemic stroke[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(6): 359-364.

参考文献

[1] 2016 Stroke Collaborators GBD.Global,regional,and national burden of stroke,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet Neurol,2019,18(5):439~458.
[2] Phipps MS,Cronin CA.Management of acute ischemic stroke[J].BMJ,2020,368:l6983.
[3] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723~1731.
[4] Balami JS,White PM,McMeekin PJ,et al.Complications of endovascular treatment for acute ischemic stroke:prevention and management[J].Int J Stroke,2018,13(4):348~361.
[5] Van Kranendonk KR,Treurniet KM,Boers AMM,et al.Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion[J].J Neurointerv Surg,2019,11(5):464~468.
[6] Suzuki Y,Nagai N,Umemura K.A review of the mechanisms of blood-brain barrier permeability by tissue-type plasminogen activator treatment for cerebral ischemia[J].Front Cell Neurosci,2016,10:2.
[7] Dentali F,Conte G,Guasti L.Neutrophil-to-lymphocyte ratio:a new prognostic factor even in patients with heart failure[J].Pol Arch Intern Med,2016,126(3):116~117.
[8] Nam KW,Kim TJ,Lee JS,et al.Neutrophil-to-lymphocyte ratio predicts early worsening in stroke due to large vessel disease[J].PloS one,2019,14(8):e0221597.
[9] Qun S,Tang Y,Sun J,et al.Neutrophil-to-lymphocyte ratio predicts 3-month outcome of acute ischemic stroke[J].Neurotox Res,2017,31(3):444~452.
[10] Liu YL,Lu JK,Yin HP,et al.High neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation in acute ischemic stroke patients treated with intravenous thrombolysis[J].Int J Hypertens,2020,2020(27):5980261.
[11] Von Kummer R,Broderick JP,Campbell BC,et al.The Heidelberg Bleeding Classification:Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy[J].Stroke,2015,46(10):2981~2986.
[12] Šwitońska M,Piekuš-Słomka N,Słomka A,et al.Neutrophil-to-lymphocyte ratio and symptomatic hemorrhagic transformation in ischemic stroke patients undergoing revascularization[J].Brain Sci,2020,10(11):771.
[13] Goyal N,Tsivgoulis G,Chang JJ,et al.Admission neutrophil-to-lymphocyte ratio as a prognostic biomarker of outcomes in large vessel occlusion strokes[J].Stroke,2018,49(8):1985~1987.
[14] Zhang WB,Zeng YY,Wang F,et al.A high neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation of large atherosclerotic infarction in patients with acute ischemic stroke[J].Aging (Albany NY),2020,12(3):2428~2439.
[15] Duan Z,Wang H,Wang Z,et al.Neutrophil-lymphocyte ratio predicts functional and safety outcomes after endovascular treatment for acute ischemic stroke[J].Cerebrovasc Dis,2018,45(5/6):221~227.
[16] Kim TJ,Park SH,Ko SB.Dynamic change of neutrophil-to-lymphocyte ratio and symptomatic intracerebral hemorrhage after endovascular recanalization therapy[J].J Stroke Cerebrovasc Dis,2022,31(9):106604.
[17] Li SJ,Cao SS,Huang PS,et al.Post-operative neutrophil-to-lymphocyte ratio and outcome after thrombectomy in acute ischemic stroke[J].Front Neurol,2022,13:990209.
[18] Spronk E,Sykes G,Falcione S,et al.Hemorrhagic trans-formation in Ischemic stroke and the role of inflammation[J].Front Neurol,2021,12:661955.
[19] Kim TJ,Park HK,Kim JM,et al.Blood pressure variability and hemorrhagic transformation in patients with successful recanalization after endovascular recanalization therapy:a retrospective observational study[J].Ann Neurol,2019,85(4):574~581.
[20] Zhang R,Wu X,Hu W,et al.Neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke:a meta-analysis[J].Brain Behav,2019,9(9):e01382.