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    中性粒细胞/淋巴细胞值、淋巴细胞/单核细胞值对急性脑梗死老年病人的临床预后价值

    Clinical value of neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio in the prognosis of elderly patients with acute cerebral infarction

      摘要
    • 摘要: 目的：探讨中性粒细胞/淋巴细胞值(neutrophil to lymphocyte ratio,NLR)、淋巴细胞/单核细胞值(lymphocyte to monocyte ratio,LMR)对急性脑梗死(acute cerebral infarction,ACI)老年病人的临床预后价值。方法：纳入ACI老年病人 968 例，根据出院3个月后改良的 Rankin量表(mRS)评分标准分为预后良好组(741例)及预后不良组(227例)，比较2组病人的临床资料、实验室检查、ACI 病因分型等的差异。采用二元 logistic回归分析急性脑梗死老年病人预后不良的影响因素。采用受试者工作特征(ROC)曲线评价 NLR、LMR水平及 NLR联合LMR对 ACI老年病人的临床预后价值。结果：预后不良组病人年龄、中性粒细胞计数与NLR水平均高于预后良好组(P<0.01)，LMR和淋巴细胞计数水平均低于预后良好组(P<0.01)；2组病因比较预后不良组多见于大动脉粥样硬化型和心源性栓塞型(P<0.01)；多因素 logistic回归分析显示，相对于心源性栓塞型，大动脉粥样硬化型是保护因素(OR=0.436，P<0.01),小动脉闭塞型是危险因素(OR=1.697，P<0.05)； NLR水平高、LMR水平高、年龄大、中性粒细胞计数升高是 ACI 老年病人预后的独立危险因素(OR=1.197、1.174、1.043、1.216，P<0.05～P<0.01)。ROC 曲线分析结果显示：NLR、LMR、NLR 联合 LMR 预测曲线下面积分别是 0.685，0.603，0.693，敏感度分别为0.493，0.379，0.678，特异度分别为 0.818，0.826，0.617。结论：NLR水平高、LMR水平高、年龄大、中性粒细胞计数升高是ACI老年病人预后不良的独立危险因素，NLR联合LMR较单一指标预测ACI老年病人的敏感性更高。

       

      Abstract: Objective: To investigate the clinical value of neutrophil to lymphocyte ratio(NLR) and lymphocyte to monocyte ratio(LMR) in the prognosis of elderly patients with acute cerebral infarction(ACI). Methods: A total of 968 elderly patients with ACI were divided into the good prognosis group(741 cases)and poor prognosis group(227 cases) according to the modified Rankin scale(mRS) scoring standard after 3 months of discharge.The clinical data,laboratory examinations and ACI etiological classification between two groups were compared.The binary logistic regression was used to analyze the influencing factors of poor prognosis in elderly patients with ACI.The receiver operating characteristic(ROC) curve was used to evaluate the prognostic value of NLR,LMR and NLR combined with LMR in elderly patients with ACI. Results: The age,neutrophil count and NLR levels in the poor prognosis group were significantly higher than those in good prognosis group(P<0.01),and the LMR and lymphocyte count levels in the poor prognosis group were significantly lower than those in good prognosis group(P<0.01).The large atherosclerotic type and cardiac embolism type in the poor prognosis group was more common(P<0.01).The results of multivariate logistic regression analysis showed that compared with cardiac embolism type,large atherosclerosis type was the protective factor(OR=0.436,P<0.01),and small artery occlusion type was the risk factor(OR=1.697,P<0.05).The high level NLR and LMR,old age and neutrophil count increasing were the independent risk factors of prognosis in elderly patients with ACI(OR=1.197,1.174,1.043,1.216,P<0.05 to P<0.01).The results of ROC curve analysis showed that the areas under the NLR,LMR and NLR combined with LMR prediction curves were 0.685,0.603 and 0.693,respectively,and the sensitivities were 0.493,0.379 and 0.678,respectively,and the specificities were 0.818,0.826,and 0.617,respectively. Conclusions: The high NLR,high LMR,old age and neutrophil count increasing are the independent risk factors of poor prognosis in elderly patients with ACI,and the NLR combined with LMR is more sensitive than single index in predicting elderly patients with ACI.

       

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