Correlation between serum hs-CRP, NLR and the therapeutic effect of edaravone dexborneol in patients with acute cerebral infarction
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摘要: 目的 观察急性脑梗死(acute cerebral infarction，ACI)患者入院时血清超敏C反应蛋白(hypersensitive C-reactive protein，hs-CRP)、中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio，NLR)水平，并分析两者与ACI患者依达拉奉右莰醇治疗效果的关系。方法 前瞻性选择2020年1月—2022年5月我院收治的280例ACI患者作为研究对象。所有患者均接受依达拉奉右莰醇治疗，并根据治疗效果分为无效组、有效组；所有患者入院时测定血清hs-CRP、NLR水平，并统计2组基线资料，分析血清hs-CRP、NLR与ACI患者依达拉奉右莰醇治疗效果的相关性。结果 280例ACI患者经依达拉奉右莰醇治疗，其中无效组26例(9.29%)，有效组254例(90.71%)；无效组神经功能缺损评分(National Institute of Health stroke scale，NIHSS)、入院时血清hs-CRP、NLR水平均高于有效组，差异有统计学意义(P < 0.05)；行多项logistics回归分析结果显示，NIHSS、入院时血清hs-CRP、NLR高表达是ACI患者依达拉奉右莰醇治疗无效的危险因素(OR>1，P < 0.05)；绘制ROC曲线结果显示，血清hs-CRP、NLR水平及联合检测ACI患者依达拉奉右莰醇治疗无效的AUC均>0.70，有一定预测价值，其中联合检测最高；绘制决策曲线，结果显示，当风险阈值为0~1时，净收益率大于0，有临床意义，且风险阈值取值越小，净收益率越大，在阈值0.1~0.8范围内，联合血清hs-CRP、NLR水平的预测模型预测ACI患者依达拉奉右莰醇治疗无效的净收益率优于单纯血清hs-CRP或单纯血清NLR。结论 血清hs-CRP、NLR与ACI患者依达拉奉右莰醇治疗效果密切相关，可有效预测患者治疗效果。
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关键词:
- 急性脑梗死 /
- 依达拉奉右莰醇 /
- 超敏C反应蛋白 /
- 中性粒细胞淋巴细胞比值 /
- 临床疗效
Abstract: Objective To observe the levels of serum hypersensitive C-reactive protein(hs-CRP) and neutrophil to lymphocyte ratio(NLR) in patients with acute cerebral infarction(ACI) at admission, and to analyze the relationship between them and the therapeutic effect of edaravone dexborneol in patients with ACI.Methods A total of 280 ACI patients treated in our hospital from January 2020 to May 2022 were prospectively selected as the research subjects. All patients were treated with edaravone dexborneol, and were divided into ineffective group and effective group according to the therapeutic effect; the levels of serum hs-CRP and NLR were measured in all patients on admission, and the baseline data of the two groups were statistically analyzed. The correlation between serum hs-CRP, NLR and the therapeutic effect of edaravone in ACI patients was analyzed.Results A total of 280 patients with ACI were treated with edaravone dexborneol, of which 26 were ineffective(9.29%) and 254 were effective(90.71%); the NIHSS score, serum hs-CRP and NLR levels at admission in the ineffective group were higher than those in the effective group, the difference was statistically significant(P < 0.05); Multiple logistic regression analysis was performed, and the results showed that NIHSS, high expression of serum hs-CRP and NLR at admission were the risk factors of ineffective treatment with edaravone dexborneol in patients with ACI(OR>1, P < 0.05); The ROC curve was drawn, and the results showed that, the AUC of serum hs-CRP and NLR levels alone and in combination for detecting ineffective treatment of edaravone dexborneol in patients with ACI were >0.70, which had certain predictive value, among which the joint detection was the highest; The decision curve was drawn, and the results showed that, when the risk threshold was 0 to 1, the net benefit rate was greater than 0, which had clinical significance. The smaller the risk threshold value was, the greater the net return rate was. When the threshold range was 0.1 to 0.8, the the net benefit rate of prediction model of combined serum hs-CRP and NLR levels in predicting ineffective treatment of edaravone dexborneol in ACI patients was better than that of single serum hs-CRP or single serum NLR.Conclusion Serum hs-CRP and NLR are closely related to the therapeutic effect of edaravone dexborneol in patients with ACI, which can effectively predict the therapeutic effect of patients. -
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表 1 2组患者基线资料比较
X±S，例(%) 临床资料 无效组(n=26) 有效组(n=254) t/χ2 P 性别 0.558 0.455 男 15(57.69) 127(50.00) 女 11(42.31) 127(50.00) 年龄/岁 59.27±7.72 57.79±7.51 0.954 0.341 BMI/(kg/m2) 27.30±2.02 26.70±1.84 1.581 0.115 病理类型 0.019 0.991 前循环梗死 15(57.69) 143(56.30) 后循环梗死 9(34.62) 91(35.83) 腔隙性梗死 2(7.69) 20(7.87) 合并糖尿病 0.437 0.508 有 2(7.69) 12(4.72) 无 24(92.31) 242(95.28) 合并高血压 0.035 0.852 有 10(38.46) 93(36.61) 无 16(61.54) 161(63.39) 合并高脂血症 0.020 0.887 有 3(11.54) 27(10.63) 无 23(88.46) 227(89.37) 吸烟史 0.277 0.598 有 14(53.85) 123(48.43) 无 12(46.15) 131(51.57) 饮酒史 0.283 0.595 有 15(57.69) 160(62.99) 无 11(42.31) 94(37.01) 发病至入院时间/h 4.71±1.24 4.99±1.18 1.146 0.253 NIHSS评分/分 7.92±2.06 6.11±1.75 4.928 < 0.001 入院时血清hs-CRP水平/(mg/L) 2.63±0.54 2.16±0.47 4.356 0.001 入院时血清NLR水平 3.48±0.54 3.03±0.42 4.438 < 0.001 
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表 2 血清hs-CRP、NLR与ACI患者依达拉奉右莰醇治疗无效的相关性
影响因素 B SE Wald P OR 95% CI 截距 -14.402 2.278 39.958 < 0.001 NIHSS 0.559 0.154 13.170 < 0.001 1.749 1.293~2.366 入院时血清hs-CRP水平 1.570 0.498 9.959 0.002 4.807 1.813~12.746 入院时血清NLR水平 1.351 0.478 7.978 0.005 3.861 1.512~9.859
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表 3 血清hs-CRP、NLR水平及联合检测ACI患者依达拉奉右莰醇治疗无效的预测价值
因素 AUC cut-off值 95% CI P 特异度 灵敏度 约登指数 入院时血清hs-CRP水平 0.722 2.415 mg/L 0.604~0.840 < 0.001 0.720 0.731 0.451 入院时血清NLR水平 0.745 3.415 0.641~0.849 < 0.001 0.831 0.654 0.485 联合检测 0.791 0.673~0.909 < 0.001 0.815 0.769 0.584
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