MHR、NLR与急性缺血性脑卒中静脉溶栓患者预后的关系

Correlation between MHR, NLR and prognosis of patients with acute ischemic stroke undergoing intravenous thrombolysis

摘要:

目的 探究单核细胞与高密度脂蛋白胆固醇比值（MHR）、中性粒细胞与淋巴细胞比值（NLR）与急性缺血性脑卒中静脉溶栓患者预后的关系。方法 回顾性分析2021年1月—2022年12月蚌埠第一人民医院收治的110例急性缺血性脑卒中患者的病历资料。收集患者的基线资料，根据患者90 d时电话随访结果分为预后良好组和预后不佳组。采用多因素逐步Logistic回归模型分析影响患者预后的高危因素；绘制受试者工作特征（ROC）曲线评估MHR、NLR对急性缺血性脑卒中静脉溶栓患者预后的预测效能。结果 110例急性缺血性脑卒中患者预后良好76例（69.09%），预后不佳34例（30.91%）。预后不佳组患者的白细胞计数、美国国立卫生研究院卒中量表（NIHSS）评分、中性粒细胞计数、单核细胞计数、MHR、NLR高于预后良好组（P <0.05），高密度脂蛋白胆固醇、淋巴细胞计数低于预后良好组（P <0.05）。多因素逐步Logistic回归分析结果显示，白细胞计数［O^R =4.125（95% CI：1.409，12.068）］、NIHSS评分［O^R =4.860（95% CI：1.662，14.218）］、高密度脂蛋白胆固醇［O^R =0.234（95% CI：0.080，0.685）］、中性粒细胞计数［O^R =3.991（95% CI：1.364，11.676）］、单核细胞计数［O^R =3.529（95% CI：1.206，10.325）］、淋巴细胞计数［O^R =0.248（95% CI：0.085，0.724）］、MHR［O^R =3.445（95% CI：1.178，10.079）］、NLR［O^R =4.043（95% CI：1.382，11.829）］均为急性缺血性脑卒中患者预后不佳的影响因素（P <0.05）。ROC曲线分析结果显示，MHR、NLR单一及联合预测急性缺血性脑卒中患者预后的敏感性分别为82.35%（95% CI：0.648，0.926）、79.41%（95% CI：0.616，0.907）、85.29%（95% CI：0.682，0.944）；特异性分别为76.32%（95% CI：0.649，0.850）、73.92%（95% CI：0.641，0.835）、88.16%（95% CI：0.782，0.941）；曲线下面积分别为0.790（95% CI：0.712，0.869）、0.801（95% CI：0.732，0.891）、0.875（95% CI：0.810，0.940）。结论 MHR、NLR水平与急性缺血性脑卒中患者的预后密切相关，且可用于预测患者的短期预后。

Abstract:

Objective To explore the correlation between monocyte-to-high-density lipoprotein cholesterol ratio (MHR), neutrophil-to-lymphocyte ratio (NLR), and the prognosis of acute ischemic stroke patients undergoing intravenous thrombolysis.Methods A retrospective analysis of medical records of 110 patients with acute ischemic stroke admitted to the First People's Hospital of Bengbu from January 2021 to December 2022 was conducted. Patient baseline data were collected, and based on the results of a 90-day telephone follow-up, patients were divided into a good prognosis group and a poor prognosis group. A multifactorial stepwise logistic regression model was used to analyze high-risk factors affecting patient prognosis. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the predictive efficacy of MHR and NLR for the prognosis of acute ischemic stroke patients undergoing intravenous thrombolysis.Results Among the 110 patients with acute ischemic stroke, 76 cases (69.09%) had a good prognosis, and 34 cases (30.91%) had a poor prognosis. Patients in the poor prognosis group had higher white blood cell count, National Institutes of Health Stroke Scale (NIHSS) score, neutrophil count, monocyte count, MHR, and NLR compared to the good prognosis group (P < 0.05). High-density lipoprotein cholesterol and lymphocyte count were lower in the poor prognosis group than in the good prognosis group (P < 0.05). White blood cell count [O^R = 4.125 (95% CI: 1.409, 12.068) ], NIHSS score [O^R = 4.860 (95% CI: 1.662, 14.218)], high-density lipoprotein cholesterol [O^R = 0.234 (95% CI: 0.080, 0.685) ], neutrophil count [O^R = 3.991 (95% CI: 1.364, 11.676) ], monocyte count [O^R = 3.529 (95% CI: 1.206, 10.325) ], lymphocyte count [O^R = 0.248 (95% CI: 0.085, 0.724) ], MHR [O^R = 3.445 (95% CI: 1.178, 10.079) ], and NLR [O^R = 4.043 (95% CI: 1.382, 11.829) ] were all influencing factors for poor prognosis in patients with acute ischemic stroke (P < 0.05). ROC curve analysis showed that the sensitivity of MHR, NLR, and their combination in predicting the prognosis of patients with acute ischemic stroke was 82.35% (95% CI: 0.648, 0.926), 79.41% (95% CI: 0.616, 0.907), and 85.29% (95% CI: 0.682, 0.944), respectively. Specificity was 76.32% (95% CI: 0.649, 0.850), 73.92% (95% CI: 0.641, 0.835), and 88.16% (95% CI: 0.782, 0.941), respectively. The area under the curve was 0.790 (95% CI: 0.712, 0.869), 0.801 (95% CI: 0.732, 0.891), and 0.875 (95% CI: 0.810, 0.940), respectively.Conclusion MHR and NLR levels are closely related to the prognosis of patients with acute ischemic stroke and can be used to predict short-term prognosis.