血清Lp-PLA2、RDW-CV、NLR值变化与急性脑梗死患者早期神经功能恶化及预后的关系

The relationship between the changes in the level of Lp-PLA2, RDW-CV and NLR with the early neurological deterioration and prognosis in patients with ACI

摘要:

目的 探讨血清脂蛋白相关磷脂酶A2（Lp-PLA2）、红细胞分布宽度变异系数（RDW-CV）、中性粒细胞与淋巴细胞比值（NLR）与急性脑梗死（ACI）患者早期神经功能恶化及预后康复的关系。方法 选取2018年5月—2022年1月青岛大学附属青岛市海慈医院收治的90例ACI患者作为ACI组，另取90例无脑血管疾病的体检志愿者作为对照组。对比两组研究对象的Lp-PLA2、RDW-CV、NLR，并按照神经功能缺损程度进行分组比较；按患者治疗3个月后的神经功能恢复情况分为预后良好组、预后不良组，采用一般多因素Logistic回归模型分析Lp-PLA2、RDW-CV、NLR与ACI患者预后结局的关系。结果 ACI组Lp-PLA2、RDW-CV、NLR高于对照组（P <0.05）。NIHSS评分≤15分ACI患者Lp-PLA2、RDW-CV、NLR低于NIHSS评分> 15分ACI患者（P <0.05）。预后良好组Lp-PLA2、RDW-CV、NLR低于预后不良组（P <0.05）。一般多因素Logistic回归分析结果显示：NIHSS评分高［O^R=1.790（95% CI：1.101，2.910）］、梗死病灶大［O^R=1.745（95% CI：1.084，2.810）］、入院时GCS评分低［O^R=0.608（95% CI：0.375，0.986）］、Lp-PLA2升高［O^R=1.677（95% CI：1.068，2.632）］、RDW-CV升高［O^R=1.737（95% CI：1.148，2.626）］、NLR升高［O^R=1.642（95% CI：1.034，2.608）］是ACI患者预后不良的危险因素（P <0.05）。结论 ACI患者血清Lp-PLA2、RDW-CV、NLR水平较非脑血管疾病患者升高，并且与早期神经功能损伤程度及患者不良预后结局关系密切。

Abstract:

Objective To explore the relationship between the serum level of lipoprotein-associated phospholipase A2 (Lp-PLA2), coefficient of variation of red cell distribution width (RDW-CV), neutrophil to lymphocyte ratio (NLR) with early neurological deterioration and prognosis of patients with acute cerebral infarction (ACI).Methods Ninety patients with ACI admitted to our Hospital from May 2018 to January 2022 were selected as the ACI group, and another 90 healthy volunteers without cerebrovascular diseases were selected as the control group. The serum level of Lp-PLA2, RDW-CV and NLR of the two groups of subjects were compared, and subgroup analysis was conducted on the patients according to their degree of neurological impairment. The patients were divided into good prognosis group and bad prognosis group based on the neurological function recovery 3 months after the treatment. The relationship between the level of Lp-PLA2, RDW-CV, and NLR with the prognosis of ACI patients was analyzed via multivariable Logistic regression models.Results The serum level of Lp-PLA2, RDW-CV, and NLR of patients in the ACI group were significantly higher than those in the control group (P < 0.05). The serum level of Lp-PLA2, RDW-CV, and NLR in ACI patients with an NIHSS score ≤ 15 were lower than those in ACI patients with an NIHSS score > 15 (P < 0.05). The serum level of Lp-PLA2, RDW-CV, and NLR in patients with good prognosis were lower than those in patients with poor prognosis (P < 0.05). The multivariable Logistic regression analysis exhibited that high NIHSS scores [O^R = 1.790 (95% CI: 1.101, 2.910) ], large-sized infarct lesions [O^R = 1.745 (95% CI: 1.084, 2.810) ], low GCS scores at admission [O^R = 0.608 (95% CI: 0.375, 0.986) ], high serum levels of Lp-PLA2 [O^R=1.677 (95% CI: 1.068, 2.632) ], high RDW-CV [O^R = 1.737 (95% CI: 1.148, 2.626) ] and high NLR [O^R = 1.642 (95% CI: 1.034, 2.608) ] were risk factors for poor prognosis in ACI patients (P < 0.05).Conclusions The serum levels of Lp-PLA2, RDW-CV and NLR in patients with ACI were significantly higher than those in patients with non-cerebrovascular diseases, and were closely related to the degree of early neurological impairment and the adverse prognosis of patients.