Predictive value of neutrophil/lymphocyte ratio for infection after ischemic stroke
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摘要: 目的:探究外周血液中中性粒细胞与淋巴细胞比值(NLR)对缺血性脑卒中相关性感染的预测价值。方法:通过查阅电子病历回顾性分析2017年12月-2019年4月期间就诊于四川大学华西医院急诊科的287例缺血性脑卒中患者的临床资料,依据缺血性脑卒中发病7 d内是否感染进行分组(感染组和非感染组),采用Logistic回归分析缺血性脑卒中感染的独立影响因素。结果:本研究对象合计纳入287例缺血性脑卒中病例,其中发生感染病例78例,占比28%。感染组NLR值(5.90±3.81)明显高于非感染组(3.19±2.02)。NLR的ROC曲线下面积为0.734,明显高于其他传统炎性指标(白细胞计数、淋巴细胞绝对值、中性粒细胞绝对值及A2DS2),多因素Logistic回归分析显示,NLR是缺血性脑卒中感染的独立影响因素(OR=1.397,95%CI:1.254~1.557,P<0.01)。结论:NLR可用于预测缺血性脑卒中患者的感染,有助于缺血性脑卒中患者入院时早期感染的分层并指导临床精准干预。Abstract: Objective:To investigate the predictive value of neutrophil/lymphocyte ratio(NLR) in peripheral blood for ischemic stroke-related infection.Methods:The clinical data of 287 patients with ischemic stroke who visited the Emergency Department of West China Hospital, Sichuan University from December 2017 to April 2019 were retrospectively analyzed by reviewing the electronic medical records and divided into infection group and non-infection group according to whether they were infected within 7 days after the onset of ischemic stroke. Logistic regression analysis was used to analyze the independent influencing factor of ischemic stroke infection.Results:A total of 287 cases of ischemic stroke were included in this study, of which 78 cases had infection, accounting for 28%. The NLR value in the infected group(5.90±3.81) was significantly higher than that in the non-infected group(3.19±2.02). The area under the ROC curve of NLR was 0.734, which was significantly higher than other traditional inflammatoryindicators(white blood cell count, absolute lymphocyte count, absolute neutrophil count and A2DS2), and multivariate Logistic regression analysis showed that NLR was an independent influencing factor of ischemic stroke infection(OR=1.397, 95%CI:1.254-1.557, P<0.01).Conclusion:NLR can be used to predict infection in patients with ischemic stroke, which is helpful for stratification of early infection in patients with ischemic stroke at admission and guiding accurate clinical intervention.
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Key words:
- neutrophil /
- lymphocyte /
- ratio /
- acute ischemic stroke /
- infection prediction
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[1] Wang YJ,Li ZX,Gu HQ,et al.China Stroke Statistics 2019:A Report From the National Center for Healthcare Quality Management in Neurological Diseases,China National Clinical Research Center for Neurological Diseases,the Chinese Stroke Association,National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations[J].Stroke Vasc Neurol,2020,5(3):211-239.
[2] 唐玉彬,张艳阳,李昭华,等.急性缺血性脑卒中的急诊科一体化溶栓治疗[J].临床急诊杂志,2020,21(9):741-743.
[3] 郭伟,李斗,彭鹏.急性缺血性脑卒中急诊急救中国专家共识(2018)[J].临床急诊杂志,2018,19(6):351-359.
[4] 毕宗勤,廖凯,田秀丽.急性缺血性脑卒中患者并发脑卒中相关性感染危险因素分析及预防对策[J].贵州医药,2021,45(2):284-285.
[5] Han S,Liu Y,LI Q,et al.Pre-treatment neutrophil-to-lymphocyle ratio is associated with neutrophil and T-cell infiltration and predicts clinical outcome in patients with glioblastoma[J].BMC Cancer,2015,15(1):617-627.
[6] Bustamante A,Vilar-Bergua A,Guettier S,et al.C-reactive protein in the detection of post-stroke infections:systematic review and individual participant data analysis[J].J Neurochem,2017,141(2):305-314.
[7] Faura J,Bustamante A,Miró-Mur F,et al.Stroke-induced immunosuppression:implications for the prevention and prediction of post-stroke infections[J].J Neuroinflammation,2021,18(1):127.
[8] Farah R,Samra N.Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke[J].J Clin Lab Anal,2018,32(1):e22189.
[9] 陈军,于光莉,徐玉新.脑卒中患者卒中相关性感染临床分析[J].中国康复理论与实践,2008,14(9):831-832.
[10] 杨进刚,杨跃进.从以病变为中心到以患者为中心:动脉粥样硬化性心血管疾病防治新概念[J].中国循环杂志,2019,34(S1):1-3.
[11] 韦伟市,吴嘉,聂汶楠,等.血常规比值参数对急性缺血性脑卒中患者的临床价值[J].医学研究生学报,2021,34(6):594-599.
[12] 冯莉莉,龚晓杰,宋琳琳,等.外周血白细胞分类计数及比值变化对流感病毒感染患者的诊断价值[J].中国实用内科杂志,2021,41(3):213-218.
[13] 戚占如,魏钟海,张静梅,等.血管内超声引导下行冠状动脉旋磨术对患者预后的影响[J].医学研究生学报,2020,33(6):613-617.
[14] 雷琦,惠晶,朱婷鸽.血非对称性二甲基精氨酸水平对短暂性脑缺血发作患者脑卒中的预测作用[J].医学研究生学报,2019,32(7):740-743.
[15] Hu Y,Huang K,Ji Z,et al.High neutrophil-to-lymphocyte ratio is associated with poor clinical outcome in patients with critically ill stroke[J].Minerva Anestesiol,2020,86(9):939-947.
[16] 吕苏,高伟波,朱继红.中性粒细胞和淋巴细胞比率与溶栓后急性脑卒中预后的关系[J].中华急诊医学杂志,2020,29(7):976-980.
[17] 张芹,程毅松,贾禹,等.中性粒细胞百分比与白蛋白比值对急性ST段抬高型心肌梗死患者预后的预测价值分析[J].临床急诊杂志,2020,21(5):354-358.
[18] Cai W,Wang J,Hu M,et al.All trans-retinoic acid protects against acute ischemic stroke by modulating neutrophil functions through STAT1 signaling[J].J Neuroinflammation,2019,16(1):175.
[19] Song SY,Zhao XX,Rajah G,et al.Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke:An Updated Meta-Analysis[J].Front Neurol,2019,10:1032.
[20] 陈云,徐敏,张力壬,等.A2DS2评分联合中性粒细胞与淋巴细胞比值对急性缺血性卒中相关性肺炎的预测价值[J].中国临床医学,2020,27(5):806-810.
[21] Vidale S,Consoli A,Arnaboldi M,et al.Postischemic Inflammation in Acute Stroke[J].J Clin Neurol,2017,13(1):1-9.
[22] 钱新宇,杨思远,Muhammad B,等.溶栓后中性粒细胞升高与缺血性脑卒中早期神经功能恶化相关性研究[J].华西医学,2019,34(6):641-648.
[23] Ruhnau J,Schulze J,Dressel A,et al.Thrombosis,Neuroinflammation,and Poststroke Infection:The Multifaceted Role of Neutrophils in Stroke[J].J Immunol Res,2017,2017:5140679.
[24] Gong S,Zhou Z,Zhou M,et al.Validation of risk scoring models for predicting stroke-associated pneumonia in patients with ischaemic stroke[J].Stroke Vasc Neurol,2016,1(3):122-126.
[25] 邹明.缺血性卒中免疫调节治疗的研究进展[J].中国卒中杂志,2020,15(1):57-62.
[26] 钟懿,熊晓星.缺血性脑卒中后免疫反应及免疫抑制相关研究进展[J].医学综述,2021,27(6):1046-1051.
[27] 金子凡,冯娟.中性粒细胞与淋巴细胞比值对原发性急性脑出血患者短期预后的预测作用[J].中国脑血管病杂志,2018,15(5):236-240,253.
[28] Wong CH,Jenne CN,Lee WY,et al.Functional innervation of hepatic iNKT cells is immunosuppressive following stroke[J].Science,2011,334(6052):101-105.
[29] 苗志娟,王修哲,赵玉武.免疫治疗在缺血性脑卒中的应用研究进展[J].中国神经免疫学和神经病学杂志,2020,27(5):394-398.
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