中性粒细胞与淋巴细胞比值预测急性腔隙性脑梗死患者病情进展的临床价值
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摘要
目的分析中性粒细胞与淋巴细胞比值(NLR)对急性腔隙性脑梗死患者病情进展的预测价值。方法根据病情进展与否将2012年2月～2017年1月收治的230例急性腔隙性脑梗死患者分为进展组(40例)与非进展组(190例),记录各组中性粒细胞绝对值、淋巴细胞绝对值等指标,计算NLR。受试者工作特征(ROC)曲线分析NLR等对急性腔隙性脑梗死患者病情进展预测的特异度、敏感度,Pearson相关性分析NLR等指标与mRS评分的关系。结果进展组NLR、白细胞计数、中性粒细胞绝对值均显著高于非进展组(P <0. 05);淋巴细胞绝对值显著低于非进展组(P <0. 05)。NLR对进展性腔隙性脑梗死(PLI)预测曲线下面积(AUC)为0. 800,最佳临界值3. 25,敏感度85. 06%,特异度70. 68%;白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值对PLI预测AUC分别为0. 650、0. 745、0. 615。进展组预后良好率显著低于非进展组(P <0. 05)。NLR、中性粒细胞绝对值、白细胞计数与mRS评分正相关(P <0. 05)。结论 NLR值对急性腔隙性脑梗死患者病情进展有一定的预测价值,有可能作为患者预后评估的有效指标。
Objective To investigate the clinical value of neutrophil-to-lymphocyte ratio( NLR) in predicting disease progression in patients with acute lacunar infarction. Methods According to the presence or absence of disease progression,230 patients with acute lacunar infarction who were admitted from February 2012 to January 2017 were divided into progression group with 40 patients and nonprogression group with 190 patients. Absolute neutrophil count and absolute lymphocyte count were recorded,and NLR was calculated.The receiver operating characteristic( ROC) curve was used to analyze the specificity and sensitivity of NLR in predicting the progression of acute lacunar infarction,and Pearson correlation analysis was used to analyze the correlation between NLR and modified Rankin Scale( mRS) score. Results Compared with the non-progression group,the progression group had significantly higher NLR,white blood cell count,and absolute neutrophil count and a significantly lower absolute lymphocyte count( P < 0. 05). NLR had an area under the ROC curve( AUC) of 0. 800 at the optimal cut-off value of 3. 25 in predicting progressive lacunar infarction( PLI),with a sensitivity of 85. 06% and a specificity of 70. 68%. The AUCs of white blood cell count,absolute neutrophil count,and absolute lymphocyte count in predicting PLI were 0. 650,0. 745,and 0. 615,respectively. The progression group had a significantly lower rate of good prognosis than the non-progression group( P < 0. 05). NLR,absolute neutrophil count,and white blood cell count were positively correlated with mRS score( P < 0. 05). Conclusions NLR has a certain value in predicting disease progression in patients with acute lacunar infarction and may be used as an effective indicator for prognostic evaluation.
Objective To investigate the clinical value of neutrophil-to-lymphocyte ratio( NLR) in predicting disease progression in patients with acute lacunar infarction. Methods According to the presence or absence of disease progression,230 patients with acute lacunar infarction who were admitted from February 2012 to January 2017 were divided into progression group with 40 patients and nonprogression group with 190 patients. Absolute neutrophil count and absolute lymphocyte count were recorded,and NLR was calculated.The receiver operating characteristic( ROC) curve was used to analyze the specificity and sensitivity of NLR in predicting the progression of acute lacunar infarction,and Pearson correlation analysis was used to analyze the correlation between NLR and modified Rankin Scale( mRS) score. Results Compared with the non-progression group,the progression group had significantly higher NLR,white blood cell count,and absolute neutrophil count and a significantly lower absolute lymphocyte count( P < 0. 05). NLR had an area under the ROC curve( AUC) of 0. 800 at the optimal cut-off value of 3. 25 in predicting progressive lacunar infarction( PLI),with a sensitivity of 85. 06% and a specificity of 70. 68%. The AUCs of white blood cell count,absolute neutrophil count,and absolute lymphocyte count in predicting PLI were 0. 650,0. 745,and 0. 615,respectively. The progression group had a significantly lower rate of good prognosis than the non-progression group( P < 0. 05). NLR,absolute neutrophil count,and white blood cell count were positively correlated with mRS score( P < 0. 05). Conclusions NLR has a certain value in predicting disease progression in patients with acute lacunar infarction and may be used as an effective indicator for prognostic evaluation.
引文
[1]欧阳红玲,田尧宇,郝春雪.hs-CRP持续升高与进展性脑梗死的关系研究[J].中国现代医学杂志,2017,27(29):118-122.
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[7]杨丹丹,陈慧丰,姚源蓉,等.缺血性进展性脑卒中的影响因素分析及预测[J].天津医药,2017,45(5):493-496.
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[9]李春,赵高峰,何谦益,等.中性粒细胞‐淋巴细胞比值与急性脑梗死的相关性分析[J].中国实用神经疾病杂志,2018,21(1):21-25.
[10]王莹莹,张健芳,蒋亚斌,等.中性粒细胞与淋巴细胞比值对急性脑梗死溶栓患者预后的预测[J].暨南大学学报(自然科学与医学版),2018,39(1):35-40.
[11]杨波,徐建银,杨利杰,等.中性粒细胞-淋巴细胞比值及D-二聚体与急性脑梗死颈动脉狭窄的关系[J].中国实用神经疾病杂志,2018,21(5):511-514.
[12]袁婷婷,王萌,赵昕,等.中性粒细胞/淋巴细胞比值和hs-CRP与急性脑梗死的相关性[J].中国神经免疫学和神经病学杂志,2016,23(3):207-209.
[13]Tokgoz S,Keskin S,Kayrak M,et al.Is Neutrophil/Lymphocyte Ratio Predict to Short-term Mortality in Acute Cerebral Infarct Independently from Infarct Volume?[J].J Stroke Cerebrovasc Dis,2014,23(8):2163-2168.
[14]姜红,黄文凤,陈玉珍,等.早期中性粒细胞与淋巴细胞比值对急性脑梗死面积的预测价值[J].中华老年心脑血管病杂志,2015,17(8):847-850.
[15]翟萌萌,王建平,余列,等.中性粒细胞与淋巴细胞比值对急性脑梗死患者预后的预测价值[J].中国脑血管病杂志,2017,14(2):82-86.
[16]Schwartz M,Moalem G.Beneficial immune activity after CNSinjury:prospects for vaccination[J].J Neuroimmunol,2001,113(2):185-192.
[17]Kim JY,Kawabori M,Yenari MA.Innate inflammatory responses in stroke:mechanisms and potential therapeutic targets[J].Curr Med Chem,2013,21(18):2076-2097.
[2]Tannd A,Erkan AF,Alhan A,et al.Arterial stiffness and central arterial wave reflection are associated with serum uric acid,total bilirubin,and neutrophil-to-lymphocyte ratio in patients with coronary artery disease[J].Anatol J Cardiol,2015,15(5):396-403.
[3]Wang RT,Zhang JR,Li Y,et al.Neutrophil-Lymphocyte ratio is associated with arterial stiffness in diabetic retinopathy in type 2 diabetes[J].J Diabetes Complicat,2014,29(2):245-249.
[4]余丹.腔隙性脑梗死诊断[J].中国热带医学,2007,7(12):2262-2263.
[5]Del BA,Palumbo V,Lamassa M,et al.Progressive lacunar stroke:review of mechanisms,prognostic features,and putative treatments[J].Int J Stroke,2012,7(4):321-329.
[6]韩忠奎,任明山,夏元亮,等.首发急性腔隙性脑梗死患者脑微出血与早期神经功能恶化的关联研究[J].医学研究生学报,2015,28(11):1160-1163.
[7]杨丹丹,陈慧丰,姚源蓉,等.缺血性进展性脑卒中的影响因素分析及预测[J].天津医药,2017,45(5):493-496.
[8]Matsumura T,Taketa K,Motoshima H,et al.Association between circulating leukocyte subtype counts and carotid intimamedia thickness in Japanese subjects with type 2 diabetes[J].Cardiovasc Diabeto l,2013,12(1):177-183.
[9]李春,赵高峰,何谦益,等.中性粒细胞‐淋巴细胞比值与急性脑梗死的相关性分析[J].中国实用神经疾病杂志,2018,21(1):21-25.
[10]王莹莹,张健芳,蒋亚斌,等.中性粒细胞与淋巴细胞比值对急性脑梗死溶栓患者预后的预测[J].暨南大学学报(自然科学与医学版),2018,39(1):35-40.
[11]杨波,徐建银,杨利杰,等.中性粒细胞-淋巴细胞比值及D-二聚体与急性脑梗死颈动脉狭窄的关系[J].中国实用神经疾病杂志,2018,21(5):511-514.
[12]袁婷婷,王萌,赵昕,等.中性粒细胞/淋巴细胞比值和hs-CRP与急性脑梗死的相关性[J].中国神经免疫学和神经病学杂志,2016,23(3):207-209.
[13]Tokgoz S,Keskin S,Kayrak M,et al.Is Neutrophil/Lymphocyte Ratio Predict to Short-term Mortality in Acute Cerebral Infarct Independently from Infarct Volume?[J].J Stroke Cerebrovasc Dis,2014,23(8):2163-2168.
[14]姜红,黄文凤,陈玉珍,等.早期中性粒细胞与淋巴细胞比值对急性脑梗死面积的预测价值[J].中华老年心脑血管病杂志,2015,17(8):847-850.
[15]翟萌萌,王建平,余列,等.中性粒细胞与淋巴细胞比值对急性脑梗死患者预后的预测价值[J].中国脑血管病杂志,2017,14(2):82-86.
[16]Schwartz M,Moalem G.Beneficial immune activity after CNSinjury:prospects for vaccination[J].J Neuroimmunol,2001,113(2):185-192.
[17]Kim JY,Kawabori M,Yenari MA.Innate inflammatory responses in stroke:mechanisms and potential therapeutic targets[J].Curr Med Chem,2013,21(18):2076-2097.