缺血性脑卒中rt-PA溶栓效果的影响因素分析和NLR的预测作用研究

高艳; 叶斌; 张红艳

doi:10.13898/j.cnki.issn.1000-2200.2023.02.032

缺血性脑卒中rt-PA溶栓效果的影响因素分析和NLR的预测作用研究

Influencing factors analysis of rt-PA thrombolytic therapy and investigation of NLR predictive effect in ischemic stroke

摘要

摘要:
目的研究缺血性脑卒中急诊阿替普酶(rt-PA)溶栓病人的预后影响因素，探讨溶栓前中性粒细胞与淋巴细胞比值(NLR)对溶栓预后的预测价值。
方法选择行急诊rt-PA溶栓治疗的缺血性脑卒中病人187例，收集可能与缺血性脑卒中预后相关的影响因素，跟踪随访并收集不同时间段的NIHSS评分和MRS评分，分别将溶栓前NIHSS评分减去溶栓后2周NIHSS评分，减分值ΔNIHSS < 2为预后较差组(65例)，ΔNIHSS≥2为预后较好组(122例)；将溶栓前MRS评分减去溶栓后3个月MRS评分，减分值ΔMRS差值< 3为预后较差组(68例)，ΔMRS≥3为预后较好组(119例)，并分析溶栓预后效果的影响因素和可能发挥预测作用的指标。
结果ΔNIHSS评分预后差组的高血压和心房颤动人数比例高于ΔNIHSS评分预后较好组(P < 0.01和P < 0.05)，ΔNIHSS评分预后差组的白细胞、中性粒细胞、NLR水平高于ΔNIHSS评分预后较好组(P < 0.01)。ΔMRS评分预后差组的心房颤动人数比例高于ΔMRS评分预后较好组(P < 0.05)，ΔMRS评分预后差组的白细胞、中性粒细胞、NLR水平高于ΔMRS评分预后较好组(P < 0.01)。进一步相关分析和线性回归分析显示，NLR分别是溶栓后ΔNIHSS评分(b=-0.173，t=2.46，P < 0.05)和以溶栓后ΔMRS评分(b=0.072，t=2.01，P < 0.05)的独立影响因素。ROC曲线分析显示NLR可以分别作为ΔNIHSS (AUC=0.595，P < 0.05，最佳临界值5.169)和ΔMRS (AUC=0.618，P < 0.05，最佳临界值6.228)预后的预测指标。
结论溶栓前NLR水平是缺血性脑卒中病人rt-PA溶栓治疗预后的独立影响因素，并且可以作为溶栓治疗效果的潜在的预测参考指标。

Abstract:
ObjectiveTo study the prognostic factors of patients with ischemic stroke after emergency rt-PA thrombolytic therapy and explore the predictive value of neutrophil to lymphocyte ratio(NLR).
MethodsA total of 187 patients with ischemic stroke who received emergency rt-PA thrombolytic therapy were selected, the influencing factors that might be related to the prognosis of ischemic stroke were collected.NIHSS score and MRS score at different time points were followed up and collected.The NIHSS score before thrombolysis was subtracted from the NIHSS score 2 weeks after thrombolysis.ΔNIHSS < 2 was considered as poor prognosis group (65 patients), and Δ NIHSS ≥ 2 was considered as good prognosis group (122 patients).The MRS score before thrombolysis was subtracted from the MRS score 3 months after thrombolysis.ΔMRS < 3 was considered as poor prognosis group (68 patients), and ΔMRS ≥ 3 was considered as good prognosis group (119 patients).Independent sample T test, Spearman correlation analysis, linear regression analysis and ROC curve analysis were used, respectively.The factors influencing the prognostic effect of thrombolytic therapy and the possible predictive indicators were analyzed.
ResultsThe proportions of patients with hypertension and atrial fibrillation in the poor ΔNIHSS score group were higher than that in the better ΔNIHSS score group (P < 0.01 and P < 0.05).The levels of leukocyte, neutrophils and NLR in the poor ΔNIHSS score group were higher than those in the better ΔNIHSS score group (P < 0.01).The proportion of patients with atrial fibrillation in the poor ΔMRS score group was higher than that in the better ΔMRS score group (P < 0.05).The levels of leukocyte, neutrophils and NLR in the poor ΔMRS score group were higher than those in the better ΔMRS score group (P < 0.01).Further correlation analysis and linear regression analysis showed that NLR was significantly associated with ΔNIHSS score (b=-0.173, t=2.46, P < 0.05) and ΔMRS score (b=0.072, t=2.01, P < 0.05) after thrombolysis.ROC curve analysis showed that NLR could be used as the predictor of ΔNIHSS (AUC=0.595, P < 0.05, the optimal cutoff value was 5.169) and ΔMRS (AUC=0.618, P < 0.05, the optimal cutoff value was 6.228).
ConclusionsNLR level before thrombolytic therapy is an independent factor which influencing the prognosis of patients with ischemic stroke after rt-PA thrombolytic therapy, and it can be used as a potential reference index to predict the efficacy of thrombolytic therapy.

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