中性粒细胞与淋巴细胞比值与急性脑梗死的相关性研究

发布时间：2018-04-14 01:10

本文选题：中性粒细胞 + 淋巴细胞　；参考：《郑州大学》2017年硕士论文

【摘要】：研究背景和目的中性粒细胞与淋巴细胞比值(Neutrophil to Lymphocyte Ratio,NLR)作为一种新的炎性指标,其在冠心病、急性冠脉综合症等患者的预后作用已得到证实,其在急性卒中患者中的作用开始引起关注。因此本研究旨在探索NLR水平与急性脑梗死患者病情严重程度、病情进展、预后以及其相关危险因素的关联,进一步分析该比值对其预后的预测价值。方法连续纳入2014年1月至2015年12月于郑州大学第五附属医院神经内科住院的急性脑梗死患者344例,其中女91例,男253例。记录入院时年龄、性别、既往病史、入院及住院72h内美国国立卫生研究院卒中量表(NIHSS)评分等资料,根据入院中性粒细胞数目(Neutrophil,N)与淋巴细胞数目(Lymphocyte,L)计算出NLR值。根据NIHSS评分,分为轻度脑梗死组(n=204例)和中重度脑梗死组(n=140例)。根据住院72h内NIHSS评分变化,分为进展性脑梗死组(56例)和非进展性脑梗死组(288例)。根据出院3个月后改良Rankin量表评分结果,分为预后良好组(n=195例)和预后不良组(n=112例),采用Logistics回归分析急性脑梗死严重程度、神经功能恶化及预后不良的影响因素,并采用受试者工作特征(ROC)曲线评价入院NLR水平等对急性脑梗死患者预后不良的预测作用。结果(1)与未合并高血压、心房纤颤以及首次脑梗死患者比较,急性脑梗死并发高血压、心房纤颤以及复发性脑梗死患者入院NLR水平偏高(均P0.05)。(2)与轻度脑梗死组比较,中重度脑梗死组入院NLR水平偏高[2.87(2.21,5.29)比2.64(1.94,3.68),P0.05],在矫正年龄、冠心病病史、复发性脑梗死病史以及TOAST分型的影响后,NLR水平与入院脑梗死严重程度相关(OR:1.100,95%CI:1.015~1.192)。(3)与非进展性脑梗死比较,进展性脑梗死组入院NLR水平偏高[3.02(2.33,4.95)比2.70(1.97,4.06),P0.05],在矫正入院NIHSS评分、年龄、冠心病病史等的影响后,NLR水平不是早期神经功能恶化的独立预测因子(OR:1.065,95%CI:0.980~1.159)。(4)与预后良好组比较,预后不良组患者入院NLR水平均较高[3.66(2.62,7.91)比2.47(1.94,3.40),P0.05],在矫正年龄、入院NIHSS评分、复发性脑梗死的影响后,NLR水平是预后不良的独立预测因子(OR:1.427,95%CI:1.247~1.634)。(5)进行ROC曲线分析发现,入院时NLR水平对急性脑梗死患者预后不良的诊断界值为2.84,其敏感度为69.6%,特异度为64.6%,曲线下面积为0.711,预测价值优于白细胞计数(WBC)、N及L(曲线下面积为:0.600,0.661,0.320)。结论(1)急性脑梗死合并高血压、心房纤颤以及复发性脑梗死中NLR水平明显升高,提示合并相关危险因素的急性脑梗死患者可能具有更高的炎症状态。(2)入院NLR水平能反应急性脑梗死患者病情严重程度,NLR水平越高,病情越严重。(3)入院时NLR水平对急性脑梗死预后有预测作用,NLR水平越高,提示预后不良的风险越大。其预测价值优于WBC、N、L。
[Abstract]:Background and objective Neutrophil to Lymphocyte Ratiotrophil as a new inflammatory marker, its prognostic role in patients with coronary heart disease and acute coronary syndrome has been confirmed.Its role in acute stroke patients is beginning to attract attention.The purpose of this study was to explore the relationship between NLR level and severity, progression, prognosis and related risk factors in patients with acute cerebral infarction, and to further analyze the prognostic value of this ratio in patients with acute cerebral infarction.Methods from January 2014 to December 2015, 344 patients with acute cerebral infarction were admitted to Department of Neurology, Fifth affiliated Hospital of Zhengzhou University, including 91 women and 253 men.Age, sex, past medical history, and NIHSS scores were recorded at admission and 72 hours after admission. The NLR values were calculated according to the number of neutrophilic neutrophil (neutrophila) and lymphocyte count (Lymphocytette).According to NIHSS score, the patients were divided into mild cerebral infarction group (n = 204) and moderate and severe cerebral infarction group (n = 140).According to the changes of NIHSS score within 72 hours of hospitalization, the patients were divided into progressive cerebral infarction group (n = 56) and non-progressive cerebral infarction group (n = 288).According to the results of modified Rankin scale after 3 months of discharge, the patients were divided into good prognosis group (n = 195) and poor prognosis group (n = 112). Logistics regression analysis was used to analyze the factors affecting the severity of acute cerebral infarction, deterioration of nerve function and poor prognosis.The predictive effect of admission NLR level on the prognosis of patients with acute cerebral infarction was evaluated by using the operating characteristics of subjects.Results compared with the patients without hypertension, atrial fibrillation and first cerebral infarction, the patients with acute cerebral infarction complicated with hypertension, atrial fibrillation and recurrent cerebral infarction had higher NLR level in admission (all P 0.05, P < 0.05), compared with the patients with mild cerebral infarction, the patients with acute cerebral infarction complicated with hypertension, patients with atrial fibrillation and patients with recurrent cerebral infarction were compared with mild cerebral infarction group.The NLR level in patients with moderate and severe cerebral infarction was higher than that in patients with moderate and severe cerebral infarction (2.87 卤2.21 卤5.29) compared with 2.641.94 卤3.68% (P0.05). After correction of age, history of coronary heart disease, history of recurrent cerebral infarction and TOAST classification, the level of NLR was correlated with the severity of cerebral infarction.The NLR level in progressive cerebral infarction group was higher than that in 2.701.97 卤4.06% group [3.02 卤2.33 卤4.95]. After correction of admission NIHSS score, age, coronary heart disease history and so on, the level of NLR was not an independent predictor of early neurological deterioration.The NLR levels in patients with poor prognosis were significantly higher [3.66 卤2.62 卤7.91] than 2.471.94 卤3.40% (P0.05). The ROC curve analysis showed that NLR level was an independent predictor of poor prognosis after correction age, admission NIHSS score and recurrent cerebral infarction (OR 1.42795: CI1.2471.634.1).At admission, the diagnostic threshold value of NLR level for poor prognosis of patients with acute cerebral infarction was 2.84, the sensitivity was 69.6, the specificity was 64.6, the area under the curve was 0.711, and the predictive value was better than that of white blood cell count (WBC).Conclusion (1) NLR levels in patients with acute cerebral infarction complicated with hypertension, atrial fibrillation and recurrent cerebral infarction were significantly increased.It is suggested that the NLR level in patients with acute cerebral infarction with associated risk factors may be higher than that in patients with acute cerebral infarction.) the higher the severity of acute cerebral infarction is, the higher the level of NLRs may be in patients with acute cerebral infarction.The more serious the condition is, the higher the NLR level is at admission to predict the prognosis of acute cerebral infarction, and the higher the level of NLR is, the higher the risk of poor prognosis is.Its predictive value is better than that of WBCN.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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