中性粒细胞-淋巴细胞比值和血小板-淋巴细胞比值预测急性轻型缺血性脑卒中患者认知障碍的价值

doi:10.3969/j.issn.1004-583X.2023.06.004

摘要/Abstract

摘要：

目的探讨急性轻型缺血性脑卒中患者中性粒细胞-淋巴细胞比值(Neutrophil-lymphocyte ratio,NLR)和血小板-淋巴细胞比值(Platelet-lymphocyte ratio,PLR)对卒中后3个月认知障碍的预测价值。方法以2020年12月至2022年5月锦州市中心医院的首发缺血性脑卒中住院患者254例为研究对象,测定患者入院时NLR和PLR,在卒中后3个月采用蒙特利尔认知评价量表(Montreal cognitive assessment,MoCA)对其进行认知功能评分。根据评分结果分为卒中后认知障碍(post-stroke cognitive impairment,PSCI)组101例和卒中后无认知障碍(no cognitive impairment,NCI)组153例。采用Logistic回归分析筛选PSCI危险因素。通过绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线分析NLR和PLR对PSCI的预测价值。结果 PSCI组NLR中位数为3.74(3.41,5.15),NCI组NLR中位数为3.15(2.80,3.82),两组差异有统计学意义( P <0.05);PSCI组PLR中位数为131.78(122.63,149.56),NCI组PLR中位数为114.70(91.44,134.52),两组差异有统计学意义( P <0.05)。Logistic回归显示NLR( OR 值:1.437,95% CI :1.045~1.978, P =0.026)和PLR( OR 值:1.011, 95% CI :1.001~1.021, P =0.030)均为PSCI的危险因素。NLR和PLR预测卒中后3个月认知障碍,NLR的ROC曲线下面积(Area under the curve,AUC)为0.695[95% CI (0.627,0.763)],最佳截断值为4.19,敏感度为43.6%,特异度为82.4%,PLR的AUC为0.677[95% CI (0.610,0.745)],最佳截断值为119.58,敏感度为79.2%,特异度为59.5%。结论缺血性卒中急性期的NLR、PLR与卒中后3个月认知障碍独立相关。NLR、PLR对卒中后3个月认知障碍有一定预测价值。

关键词: 缺血性卒中, 认知障碍, 中性粒细胞-淋巴细胞比值, 血小板-淋巴细胞比值

Abstract:

Objective To investigate the value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting cognitive impairment at 3 months of acute mild ischemic stroke. Methods A total of 254 hospitalized patients with an initial ischemic stroke from December 2020 to May 2022 in Central Hospital of Jinzhou were selected as the study objects.NLR and PLR were measured at admission. Cognitive function was evaluated at 3 months of stroke by the Montreal Cognitive Assessment (MoCA). According to the MoCA score, patients were classified into post-stroke cognitive impairment group (PSCI group, n=101)and non-cognitive impairment group(NCI group, n =153). Logistic regression was used to screen the risk factors of PSCI. The predictive values of NLR and PLR in PSCI were analyzed by drawing the receiver operating characteristic (ROC) curves.Resultss There were significant differences in the median NLR (3.74[3.41, 5.15] vs 3.15[2.80, 3.82]) and PLR (131.78 [122.63, 149.56] vs 114.70[91.44, 134.52]) between PSCI group and NCI group (both P <0.05). Logistic regression showed that both NLR ( OR =1.437, 95% CI : 1.045-1.978, P =0.026) and PLR ( OR =1.011, 95% CI : 1.001-1.021, P =0.030) were risk factors for PSCI. The area under the curve (AUC) of NLR in predicting cognitive impairment at 3 months of stroke was 0.695(95% CI : 0.627, 0.763), with the cut-off value, sensitivity and specificity of 4.19, 43.6% and 82.4%, respectively. The AUC of PLR in predicting cognitive impairment at 3 months of stroke was 0.677(95% CI : 0.610, 0.745), with the cut-off value, sensitivity and specificity of 119.58, 79.2% and 59.5%, respectively.Conclusion NLR and PLR in the acute phase of ischemic stroke are independently correlated with cognitive impairment at 3 months of stroke, which can predict cognitive impairment at 3 months of stroke.

Key words: ischemic stroke, cognitive impairment, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio

中图分类号:

R743.3

辛燕红, 郎桂艳, 陈子为, 王东玉. 中性粒细胞-淋巴细胞比值和血小板-淋巴细胞比值预测急性轻型缺血性脑卒中患者认知障碍的价值[J]. 临床荟萃, 2023, 38(6): 504-509.

Xin Yanhong, Lang Guiyan, Chen Ziwei, Wang Dongyu. Value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in predicting cognitive impairment in patients with acute mild ischemic stroke[J]. Clinical Focus, 2023, 38(6): 504-509.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.06.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I6/504

图/表 3

表1 两组基线临床资料及NLR、PLR的比较

Tab. 1 Comparison of baseline clinical data, NLR and PLR between groups

项目	NCI组( $n$ =153)	PSCI组( $n$ =101)	$t$ /χ²/ $Z$ 值	$P$ 值
年龄(岁)	60.50±8.605	62.99±7.138	-2.414	0.016
男性[例(%)]	93(60.8)	57(56.4)	0.476	0.490
受教育年龄≤9年[例(%)]	48(31.4)	50(49.5)	8.362	0.004
高血压[例(%)]	85(55.6)	64(63.4)	1.531	0.216
糖尿病[例(%)]	51(33.3)	38(37.6)	0.492	0.483
高同型半胱氨酸血症[例(%)]	46(30.1)	38(37.6)	1.570	0.210
HBP+DM +HHcy[例(%)]	5(3.3)	12(11.9)	9.583	0.007
高脂血症[例(%)]	70(45.8)	59(58.4)	3.904	0.048
吸烟史[例(%)]	69(45.1)	43(42.6)	0.157	0.692
饮酒史[例(%)]	42(27.5)	24(23.8)	0.430	0.512
心房颤动[例(%)]	9(5.9)	8(7.9)	0.405	0.525
冠心病[例(%)]	13(8.5)	14(13.9)	1.843	0.175
NIHSS^#	2.00(1.0,3.0)	3.0(1.0,4.0)	-1.720	0.085
卒中分型(TOAST)[例(%)]
大动脉粥样硬化	62(40.5)	47(46.5)
心源性栓塞	4(2.6)	2(2.0)
小血管闭塞	80(52.3)	47(46.5)	1.470	0.884
其他原因型	1(0.7)	1(1.0)
不明原因型	6(3.9)	4(4.0)
DMTS^△	10.05(7.10,16.55)	14.15(10.68,17.70)	-4.147	<0.01
≥2个梗死灶数量[例(%)]	54(35.3)	38(37.6)	0.143	0.705
关键部位梗死^▲[例(%)]	37(24.2)	42(41.6)	8.597	0.003
幕上/幕下梗死[例(%)]
幕上	67(43.8)	57(56.4)
幕下	70(45.8)	30(29.7)	6.569	0.037
幕上下	16(10.5)	14(13.9)
尿酸	295.60(241.80,359.20)	309.00(258.95,366.74)	-1.359	0.174
NLR	3.15(2.80,3.82)	3.74(3.41,5.15)	-5.267	<0.01
PLR	114.70(91.44,134.52)	131.78(122.63,149.56)	-4.784	<0.01

表1 两组基线临床资料及NLR、PLR的比较

Tab. 1 Comparison of baseline clinical data, NLR and PLR between groups

项目	NCI组( $n$ =153)	PSCI组( $n$ =101)	$t$ /χ²/ $Z$ 值	$P$ 值
年龄(岁)	60.50±8.605	62.99±7.138	-2.414	0.016
男性[例(%)]	93(60.8)	57(56.4)	0.476	0.490
受教育年龄≤9年[例(%)]	48(31.4)	50(49.5)	8.362	0.004
高血压[例(%)]	85(55.6)	64(63.4)	1.531	0.216
糖尿病[例(%)]	51(33.3)	38(37.6)	0.492	0.483
高同型半胱氨酸血症[例(%)]	46(30.1)	38(37.6)	1.570	0.210
HBP+DM +HHcy[例(%)]	5(3.3)	12(11.9)	9.583	0.007
高脂血症[例(%)]	70(45.8)	59(58.4)	3.904	0.048
吸烟史[例(%)]	69(45.1)	43(42.6)	0.157	0.692
饮酒史[例(%)]	42(27.5)	24(23.8)	0.430	0.512
心房颤动[例(%)]	9(5.9)	8(7.9)	0.405	0.525
冠心病[例(%)]	13(8.5)	14(13.9)	1.843	0.175
NIHSS^#	2.00(1.0,3.0)	3.0(1.0,4.0)	-1.720	0.085
卒中分型(TOAST)[例(%)]
大动脉粥样硬化	62(40.5)	47(46.5)
心源性栓塞	4(2.6)	2(2.0)
小血管闭塞	80(52.3)	47(46.5)	1.470	0.884
其他原因型	1(0.7)	1(1.0)
不明原因型	6(3.9)	4(4.0)
DMTS^△	10.05(7.10,16.55)	14.15(10.68,17.70)	-4.147	<0.01
≥2个梗死灶数量[例(%)]	54(35.3)	38(37.6)	0.143	0.705
关键部位梗死^▲[例(%)]	37(24.2)	42(41.6)	8.597	0.003
幕上/幕下梗死[例(%)]
幕上	67(43.8)	57(56.4)
幕下	70(45.8)	30(29.7)	6.569	0.037
幕上下	16(10.5)	14(13.9)
尿酸	295.60(241.80,359.20)	309.00(258.95,366.74)	-1.359	0.174
NLR	3.15(2.80,3.82)	3.74(3.41,5.15)	-5.267	<0.01
PLR	114.70(91.44,134.52)	131.78(122.63,149.56)	-4.784	<0.01

表2 PSCI影响因素Logistic回归分析

Tab.2 Logistic regression analysis of influencing factors for PSCI

危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.022	0.033	0.435	0.510	1.022	0.957	1.091
受教育水平	0.424	0.302	1.969	0.161	1.528	0.845	2.762
HBP+DM+HHcy	1.300	0.646	4.046	0.044	3.668	1.034	13.014
高脂血症	0.360	0.292	1.525	0.217	1.433	0.809	2.538
NIHSS	-0.049	0.122	0.159	0.690	0.952	0.750	1.210
DMTS	0.037	0.049	0.561	0.454	1.037	0.942	1.142
关键部位梗死	0.714	0.323	4.886	0.027	2.042	1.084	3.846
幕上幕下梗死	4.364	0.113
幕下	0				1
幕上	0.160	0.471	0.115	0.734	1.173	0.467	2.951
幕上下	-0.050	0.484	1.076	0.300	0.606	0.235	1.563
NLR	0.363	0.163	4.968	0.026	1.437	1.045	1.978
PLR	0.011	0.005	4.737	0.030	1.011	1.001	1.021

表2 PSCI影响因素Logistic回归分析

Tab.2 Logistic regression analysis of influencing factors for PSCI

危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.022	0.033	0.435	0.510	1.022	0.957	1.091
受教育水平	0.424	0.302	1.969	0.161	1.528	0.845	2.762
HBP+DM+HHcy	1.300	0.646	4.046	0.044	3.668	1.034	13.014
高脂血症	0.360	0.292	1.525	0.217	1.433	0.809	2.538
NIHSS	-0.049	0.122	0.159	0.690	0.952	0.750	1.210
DMTS	0.037	0.049	0.561	0.454	1.037	0.942	1.142
关键部位梗死	0.714	0.323	4.886	0.027	2.042	1.084	3.846
幕上幕下梗死	4.364	0.113
幕下	0				1
幕上	0.160	0.471	0.115	0.734	1.173	0.467	2.951
幕上下	-0.050	0.484	1.076	0.300	0.606	0.235	1.563
NLR	0.363	0.163	4.968	0.026	1.437	1.045	1.978
PLR	0.011	0.005	4.737	0.030	1.011	1.001	1.021

表3 ROC曲线分析

Tab 3 Analysis of ROC curve analysis

危险因素	AUC	敏感度	特异度	约登指数	临界值	$P$ 值	95% $C I$
危险因素	AUC	敏感度	特异度	约登指数	临界值	$P$ 值	下限	上限
NLR	0.695	0.436	0.824	0.260	4.19	<0.01	0.627	0.763
PLR	0.677	0.792	0.595	0.387	119.58	<0.01	0.610	0.745

表3 ROC曲线分析

Tab 3 Analysis of ROC curve analysis

危险因素	AUC	敏感度	特异度	约登指数	临界值	$P$ 值	95% $C I$
危险因素	AUC	敏感度	特异度	约登指数	临界值	$P$ 值	下限	上限
NLR	0.695	0.436	0.824	0.260	4.19	<0.01	0.627	0.763
PLR	0.677	0.792	0.595	0.387	119.58	<0.01	0.610	0.745

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