NLR、PLR、MPV对急性脑梗死超早期静脉溶栓治疗神经功能转归的预测价值

Predictive values of NLR, PLR and MPV on neurological outcomes after ultra-early intravenous thrombolytic therapy in patients with acute cerebral infarction

摘要:

目的 探究中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、血小板平均体积（MPV）对急性脑梗死（ACI）超早期静脉溶栓治疗神经功能转归的预测价值。方法 选取2020年9月—2022年4月滁州市第一人民医院收治的103例ACI患者作为研究对象，入院后检测NLR、PLR、MPV水平，采取尿激酶或阿替普酶静脉溶栓治疗，并于治疗1周后参考美国国立卫生院卒中量表（NIHSS）评分分为良好组和损伤组。分析影响ACI患者静脉溶栓后神经功能转归的危险因素；绘制受试者工作特征（ROC）曲线，分析NLR、PLR、MPV对ACI静脉溶栓后神经功能转归的预测效能。结果 103例ACI患者治疗1周后，NIHSS评分≤ 6分患者81例（78.64%），NIHSS评分> 6分患者22例（21.36%）。损伤组年龄、高血压占比、NLR、PLR、MPV水平高于良好组（P <0.05）。一般多因素Logistic回归分析结果显示：高龄［O^R=3.494（95% CI：1.194，10.222）］、高血压［O^R=3.155（95% CI：1.078，9.231）］、NLR升高［O^R=4.076（95% CI：1.393，11.924）］、PLR升高［O^R=3.971（95% CI：1.357，11.618）］、MPV升高［O^R=3.655（95% CI：1.249，10.692）］是ACI患者神经功能损伤的危险因素（P <0.05）。ROC曲线分析结果显示，NLR、PLR、MPV单一及联合预测ACI溶栓后神经功能转归的敏感性分别为84.09%、75.00%、79.55%和81.82%，特异性分别为61.73%、70.37%、71.75%和76.54%，曲线下面积分别为0.742、0.749、0.737和0.819。结论 NLR、PLR、MPV可用于预测ACI患者静脉溶栓后神经功能的转归结局，且预测效能良好。

Abstract:

Objective To explore the predictive values of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) on neurological outcomes after ultra-early intravenous thrombolytic therapy in patients with acute cerebral infarction.Methods A total of 103 patients with acute cerebral infarction treated in Chuzhou First People's Hospital from September 2020 to April 2022 were selected. After admission, NLR, PLR and MPV were detected. The patients were treated with intravenous thrombolysis via urokinase or alteplase. After one week of treatment, they were divided into the outcome group and the injury group according to the National Institutes of Health Stroke Scale (NIHSS) score. The risk factors affecting the neurological outcomes after intravenous thrombolysis in patients with acute cerebral infarction were analyzed. The predictive efficacy of NLR, PLR and MPV on the neurological outcomes after intravenous thrombolysis in patients with acute cerebral infarction was determined via the receiver operating characteristic (ROC) curve analysis.Results After one week of treatment, the NIHSS score was no more than 6 in 81 cases (78.64%), and was more than 6 in 22 cases (21.36%). The age, NLR, PLR, MPV and the proportion of patients with hypertension in the injury group were higher than those in the outcome group (P < 0.05). Multivariable Logistic analysis showed that advanced age [O^R = 3.494 (95% CI: 1.194, 10.222) ], hypertension [O^R = 3.155 (95% CI: 1.078, 9.231) ], and elevated NLR [O^R = 4.076 (95% CI: 1.393, 11.924) ], PLR [O^R = 3.971 (95% CI: 1.357, 11.618) ] and MPV [O^R = 3.655 (95% CI: 1.249, 10.692) ] were risk factors for neurological impairment in patients with acute cerebral infarction (P < 0.05). The ROC curve analysis revealed that the sensitivities of NLR, PLR and MPV alone and their combination for predicting the neurological outcomes after thrombolysis were 84.09%, 75.00%, 79.55%, and 81.82%, with the specificities being 61.73%, 70.37%, 71.75%, and 76.54%, and areas under the ROC curves being 0.742, 0.749, 0.737 and 0.819, respectively.Conclusions NLR, PLR and MPV can be employed to well predict the outcome of neurological function after intravenous thrombolysis in patients with acute cerebral infarction.