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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 396 -403. doi: 10.3877/cma.j.issn.2095-5782.2022.04.010

神经介入

围术期NLR变化可预测急性前循环大血管闭塞性卒中取栓患者的临床预后
林枫1, 张鸿运1, 贺迎坤1, 李天晓1,†()   
  1. 1. 450003　河南郑州，郑州大学人民医院介入中心脑血管病科；河南省人民医院卒中中心神经外科；河南省神经介入研发与应用工程研究中心；河南省脑血管介入创新工程技术研究中心；河南省脑血管国际联合实验室
  • 收稿日期:2022-05-24 出版日期:2022-11-25
  • 通信作者: 李天晓
  • 基金资助:
    国家脑卒中高危人群干预适宜技术研究及推广项目(GN-2018R0007); 河南省医学科技公关计划省部共建项目(SBGJ2018063)

Perioperative NLR can predict the clinical prognosis of patients with acute anterior circulation large vessel occlusive stroke after thrombectomy

Feng Lin1, Hongyun Zhang1, Yingkun He1, Tianxiao Li1,†()   

  1. 1. Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital; Neurosurgery Department of Stroke Center, Henan Provincial People's Hospital; Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, Henan Engineering Research Center of Cerebrovascular Intervention Innovation , Henan International Joint Laboratory of cerebrovascular, Henan Zheng Zhou 450003, China
  • Received:2022-05-24 Published:2022-11-25
  • Corresponding author: Tianxiao Li
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引用本文：

林枫, 张鸿运, 贺迎坤, 李天晓. 围术期NLR变化可预测急性前循环大血管闭塞性卒中取栓患者的临床预后[J]. 中华介入放射学电子杂志, 2022, 10(04): 396-403.

Feng Lin, Hongyun Zhang, Yingkun He, Tianxiao Li. Perioperative NLR can predict the clinical prognosis of patients with acute anterior circulation large vessel occlusive stroke after thrombectomy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 396-403.

目的

探讨入院时中性粒细胞/淋巴细胞比值（neutrophils to lymphocyte ratio，NLR）、血管内机械取栓术后3~7 d NLR和围术期NLR变化与接受取栓治疗的前循环大血管闭塞性急性缺血性卒中患者临床预后关系。

方法

回顾性分析2018年1月至2021年6月在郑州大学人民医院接受血管内机械取栓治疗的前循环大血管闭塞性急性缺血性卒中患者的基线数据、临床表现和手术相关指标，将入院时NLR定义为NLR1，术后3~7 d NLR定义为NLR2，NLR2-NLR1定义为围术期NLR变化。根据术后90 d改良Rankin量表（modified Rankin scale，mRS）评分将患者分为临床预后良好组和临床预后不良组，将单因素分析P < 0.05的因素纳入Logistics多因素回归分析中，探讨NLR1、NLR2及围术期NLR变化与临床预后的关系。

结果

本研究共纳入332例患者，其中268例（80.7%）患者实现成功再灌注，术后90 d随访时有147例（44.3%）患者临床预后良好。单因素分析显示，NLR2较低和围术期NLR变化较低与临床预后、成功再灌注、症状性颅内出血和术后90 d随访时死亡率有统计学意义（P < 0.05）；进一步多变量Logistic分析表明，年龄（OR：1.063，95%CI：1.034~1.092，P < 0.001）、侧支循环（OR：0.454，95%CI：0.249~0.829，P = 0.010）、首次通过再灌注（OR：0.318，95%CI：0.172~0.589，P < 0.001）、围术期NLR变化（OR：2.474，95%CI：1.964~3.117，P < 0.001）是临床预后的独立预测因素。受试者工作特征曲线分析发现，围术期NLR变化截断值为3.42时，预测临床预后敏感性和特异性分别为81.1%、74.1%。

结论

取栓术后3~7 d NLR和围术期NLR变化与成功再灌注、症状性颅内出血和死亡率相关，围术期NLR变化是临床预后的独立预测因子。

关键词: 前循环大血管闭塞, 急性缺血性卒中, 机械取栓, 中性粒细胞与淋巴细胞比值, 临床预后
Objective

To investigate the relationship between the clinical prognosis of acute ischemic stroke patients with anterior circulation large vessel occlusion treated with thrombectomy and neutrophils to lymphocyte ratio (NLR) at admission, NLR 3-7 days after operation and the changes of perioperative NLR.

Methods

This study retrospectively analyze the patients with anterior circulation large vessel occlusive acute ischemic stroke who underwent thrombectomy in Zhengzhou University People's Hospital from January 2018 to June 2021. The baseline data, clinical manifestations and operation related indexes were collected. The patients were divided into good clinical prognosis group and poor clinical prognosis group according to the modified Rankin scale score 90 days after operation, NLR at admission was defined as NLR1, NLR at 3-7 days after operation was defined as NLR2, and NLR2-NLR1 was defined as the change of perioperative NLR. The factors with P < 0.05 in univariate analysis were included in logistic multivariate regression analysis to explore the relationship between NLR1, NLR2 and perioperative NLR and clinical prognosis, and to explore whether these indicators can predict the clinical prognosis.

Results

A total of 332 patients with anterior circulation large vessel occlusive AIS treated with MT were included in this study, of which 268 (80.7%) achieved successful reperfusion. At the 90 day follow-up, 147 (44.3%) patients had a good clinical prognosis. Univariate analysis showed that lower NLR2 and smaller perioperative NLR changes were significantly associated with clinical prognosis, successful reperfusion, symptomatic intracranial hemorrhage (sICH) and mortality at 90 day follow-up (P < 0.05). Multivariate logistic analysis showed that age (OR: 1.063, 95%CI: 1.034-1.092, P < 0.001), collateral circulation (OR: 0.454, 95%CI: 0.249-0.829, P = 0.01), first reperfusion (OR: 0.318, 95%CI: 0.172 -0.589, P < 0.001) and perioperative NLR changes (OR: 2.474, 95%CI: 1.964-3.117, P < 0.001) were independent predictors of clinical prognosis. Receiver Operating Characteristic Curve showed that when the cut-off value of perioperative NLR change was 3.42, the sensitivity and specificity of predicting clinical prognosis were 81.1% and 74.1% respectively.

Conclusions

NLR2 and the change of perioperative NLR are associated with successful reperfusion, sICH and mortality, and the changes of perioperative NLR is an independent predictor of good clinical prognosis.

Key words: Anterior circulation large vessel occlusion, Acute ischemic stroke, Mechanical thrombectomy, Neutrophil to Lymphocyte Ratio, Clinical prognosis
表1 临床预后良好组和预后不良组的基本资料对比
  预后良好组（n = 147） 预后不良组（n = 185） 检验值 P值
年龄（±s） 61.05 ± 11.94 71.19 ± 10.30 -8.299 < 0.001
女性[n（%）] 75（51.0） 96（51.9） 0.025 0.875
既往卒中史[n（%）] 49（33.3） 75（40.5） 1.818 0.178
高血压 75（51.0） 116（62.7） 4.575 0.032
糖尿病 33（22.4） 40（21.6） 0.033 0.875
心房颤动 31（21.1） 60（32.4） 5.298 0.021
侧支循环[n（%）]     10.868 < 0.001
  良好 79（53.7） 66（35.7）    
  不良 68（46.3） 119（64.3）    
术前Mrs 0~2 [n（%）] 51（34.7） 55（29.7） 0.929 0.335
NIHSS [M（Q1，Q3）] 16（15，17） 15（14，17） -0.713 0.476
ASPECTS [M（Q1，Q3）] 9（8，10） 9（8，9） -2.227 0.026
溶栓史[n（%）] 33（22.4） 42（22.7） 0.003 0.956
核心梗死体积（n = 14）[M（Q1，Q3）] 34.5（17.25，44.75） 69（42.5，104） -1.034 0.301
发病到穿刺时间[M（Q1，Q3）] 324（282，421） 328（255.5，447） -0.434 0.664
穿刺到再通时间[M（Q1，Q3）] 125（100，170） 136（95，180） -0.741 0.458
闭塞部位[n（%）]     5.249 0.154
  ICA 59（40.1） 88（47.6）    
  MCA M1 69（47.0） 79（42.7）    
  MCA M2 19（12.9） 18（9.7）    
取栓方式[n（%）]     1.776 0.620
  血栓抽吸 33（22.4） 48（25.9）    
  支架取栓 71（48.3） 86（46.5）    
  中间导管辅助取栓 23（15.6） 33（17.8）    
  支撑导管辅助支架取栓 20（13.6） 18（9.7）    
取栓装置操作次数[M（Q1，Q3）] 1（1，2） 2（1，3） -4.853 < 0.001
FPR [n（%）] 91（61.9） 65（35.1） 23.565 < 0.001
mTICI≥2B [n（%）] 132（89.8） 136（73.5） 13.956 < 0.001
sICH [n（%）] 6（4.1） 30（16.2） 12.476 0.001
90 d死亡[n（%）] 0（0） 16（8.6） 11.566a 0.001
NLR1[M（Q1，Q3）] 3.90（3.09，4.87） 4.08（3.19，4.96） -0.523 0.601
NLR2[M（Q1，Q3）] 6.51（5.35，7.99） 8.91（7.45，10.29） -8.819 < 0.001
∆NLR[M（Q1，Q3）] 2.45（1.64，3.53） 4.61（3.67，5.68） -10.794 < 0.001
图1 NLR2值和围术期NLR变化值与再灌注、预后、sICH及死亡率的关系1A：较低的NLR2及围术期NLR变化与临床预后良好有关；1B：再灌注成功与NLR2及围术期NLR变化较小有明显相关；1C：较高的NLR2及围术期NLR变化与术后出现sICH呈正相关；1D：较高的NLR2及围术期NLR变化与术后90 d的死亡率呈正相关。
表2 入院时和术后3~7 d时的中性粒细胞、淋巴细胞和NLR对比
  入院 术后3~7 d 检验值 P值
中性粒细胞 6.44 (5.47，7.45) 8.88 (7.34，9.84) -14.618 < 0.001
淋巴细胞 1.67 (1.39，1.91) 1.13 (0.96，1.28) -15.093 < 0.001
NLR 4.01 (3.16，4.93) 7.67 (6.24，9.44) -15.792 < 0.001
表3 mTICI 2b~3和mTICI < 2b不同阶段NLR的对比
  mTICI 2b~3 mTICI < 2b Z值 P值
NLR1[M（Q1，Q3）] 4.08（3.17，4.94） 3.81（3.13，4.75） -1.066 0.286
NLR2[M（Q1，Q3）] 7.54（6.02，9.22） 8.61（7.19，10.34） -3.108 0.002
∆NLR[M（Q1，Q3）] 3.46（2.26，4.86） 4.70（3.66，6.08） -4.908 < 0.001
表4 有无sICH发生不同阶段NLR的对比
  无sICH sICH Z值 P值
NLR1[M（Q1，Q3）] 4.02（3.18，4.93） 3.80（2.98，4.99） -0.668 0.504
NLR2[M（Q1，Q3）] 7.57（6.12，9.16） 9.23（6.89，10.52） -3.115 0.002
∆NLR[M（Q1，Q3）] 3.53（2.30，5.01） 4.62（3.90,6.16） -4.339 < 0.001
表5 90 d有无死亡发生不同阶段NLR的对比
  无死亡 死亡 Z值 P值
NLR1[M（Q1，Q3）] 3.97（3.13，4.85） 4.69（3.33，5.25） -1.257 0.209
NLR2[M（Q1，Q3）] 7.57（6.17，9.23） 9.59（7.47，10.60） -2.919 0.004
∆NLR[M（Q1，Q3）] 3.65（2.38，5.05） 4.80（4.33，5.50） -2.959 0.003
表6 临床预后的Logistics回归分析
变量 B 标准误差 瓦尔德 P值 OR值（95%CI）
年龄 0.061 0.014 9.463 < 0.001 1.063（1.034~1.092）
侧支循环 -0.790 0.307 6.611 0.010 0.454（0.249~0.829）
FPR -1.145 0.314 13.317 < 0.001 0.318（0.172~0.589）
∆NLR 0.906 0.118 19.463 < 0.001 2.474（1.964~3.117）
图2 ?NLR的ROC曲线
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