作者：伍小山，罗华

单位：

646000 四川省泸州市，西南医科大学附属医院神经内科；通信作者：罗华，E-mail：lzlh@sina.com

Units：

Department of Neurology，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China；Corresponding author：LUO Hua，E-mail：lzlh@sina.com

关键词：

脑梗死；出血性转化；中性粒细胞；淋巴细胞；中性粒细胞与淋巴细胞比值；预测

Keywords：

Brain infarction；Hemorrhagic transformation；Neutrophil count；Lymphocyte count；Neutrophil tolymphocyte ratio；Forecasting

CLC：

R 743.33

DOI：

Funds：

四川省应用基础研究计划项目（14JC0166）

摘要：

背景　出血性转化（HT）是急性脑梗死尤其是急性大面积脑梗死（AMCI）患者的严重并发症之一，中性粒细胞与淋巴细胞比值（NLR）是评估脑血管疾病患者预后的一种新型炎性指标，但目前关于 NLR 与 AMCI 患者HT 关系的研究报道较少。目的　探讨 NLR 对 AMCI 患者 HT 的预测价值。方法　选取 2013 年 8 月—2018 年 9 月西南医科大学附属医院神经内科收治的 AMCI 患者 192 例，根据 HT 发生情况分为 HT 组 65 例和非 HT 组 127 例。比较两组患者一般资料、实验室检查指标，AMCI 患者 HT 影响因素分析采用多因素 Logistic 回归分析，绘制 ROC 曲线以评价白细胞计数（WBC）、中性粒细胞计数、淋巴细胞计数、NLR 对 AMCI 患者 HT 的预测价值。结果　（1）HT 组患者年龄大于非 HT 组，心房颤动发生率、WBC、中性粒细胞计数、NLR 高于非 HT 组，淋巴细胞计数低于非 HT 组（P<0.05）；两组患者性别、高血压发生率、糖尿病发生率、冠心病发生率、有饮酒史者占比、有吸烟史者占比、美国国立卫生研究院卒中量表（NIHSS）评分、收缩压、舒张压、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖比较，差异无统计学意义（P>0.05）。（2）多因素Logistic回归分析结果显示，心房颤动〔OR=4.642，95%CI（1.888，11.416）〕、WBC〔OR=1.170，95%CI（1.023，1.338）〕、中性粒细胞计数〔OR=1.133，95%CI（1.006，1.276）〕、淋巴细胞计数〔OR=1.873，95%CI（1.330，2.639）〕、NLR〔OR=1.450，95%CI（1.258，1.670）〕是 AMCI 患者 HT 的独立影响因素（P<0.05）。（3）ROC 曲线显示，WBC、中性粒细胞计数、淋巴细胞计数、NLR预测AMCI患者HT的曲线下面积（AUC）分别为0.653〔95%CI（0.570，0.736）〕、0.681〔95%CI（0.600，0.762）〕、0.582〔95%CI（0.492，0.672）〕、0.772〔95%CI（0.697，0.847）〕；NLR 预 测AMCI 患者 HT 的 AUC 大于 WBC、淋巴细胞计数（P<0.05）；NLR 与中性粒细胞计数预测 AMCI 患者 HT 的 AUC 比较，差异无统计学意义（P>0.05）。结论　心房颤动、WBC、中性粒细胞计数、淋巴细胞计数、NLR 是 AMCI 患者 HT 的独立影响因素，其中 NLR 对 AMCI 患者 HT 的预测价值较高。

Abstract：

Background　Hemorrhagic transformation（HT）is one of serious complications of acute cerebralinfarction especially acute massive cerebral infarction（AMCI），neutrophil to lymphocyte ratio（NLR）is a new inflammatoryindicator to evaluate the prognosis of patients with cerebrovascular diseases，but there is few researches about the relationshipbetween NLR and HT in AMCI patients at present. Objective　To investigate the predictive value of NLR on HT in patients withAMCI. Methods　From August 2013 to September 2018，a total of 192 patients with AMCI were selected in the Department ofNeurology，the Affiliated Hospital of Southwest Medical University，and they were divided into HT group（n=65）and non-HTgroup（n=127）according to the incidence of HT. General information and laboratory examination results were compared betweenthe two groups，and the influencing factors of HT in patients with AMCI were analyzed by multivariate Logistic regression analysis，moreover ROC curve was drawn to analyze the predictive value of WBC，neutrophil count，lymphocyte count and NLR on HT inpatients with AMCI. Results　（1）Age in HT group was statistically significantly older than that in non-HT group，incidenceof atrial fibrillation，WBC，neutrophil count and NLR in HT group were statistically significantly higher than those in non-HTgroup，while lymphocyte count in HT group was statistically significantly lower than that in non-HT group（P<0.05）；there wasno statistically significant difference in gender，incidence of hypertension，diabetes or coronary heart disease，proportion ofpatients with history of drinking or smoking，NIHSS score，SBP，DBP，TC，TG，HDL-C，LDL-C or FPG between the twogroups（P>0.05）.（2）Multivariate Logistic regression analysis results showed that，atrial fibrillation〔OR=4.642，95%CI（1.888，11.416）〕，WBC〔OR=1.170，95%CI（1.023，1.338）〕，neutrophil count〔OR=1.133，95%CI（1.006，1.276）〕，lymphocyte count〔OR=1.873，95%CI（1.330，2.639）〕and NLR〔OR=1.450，95%CI（1.258，1.670）〕were independent influencing factors of HT in patients with AMCI（P<0.05）.（3）ROC curve showed that，AUC of WBC，neutrophil count，lymphocyte count and NLR was 0.653〔95%CI（0.570，0.736）〕，0.681〔95%CI（0.600，0.762）〕，0.582〔95%CI（0.492，0.672）〕and 0.772〔95%CI（0.697，0.847）〕in predicting HT in patients with AMCI，respectively；AUC of NLR was statistically significantly greater than that of WBC，lymphocyte count in predicting HT in patients with AMCI，respectively（P<0.05），but there was no statistically significant difference in AUC between NLR and neutrophil count inpredicting HT in patients with AMCI（P>0.05）. Conclusion　Atrial fibrillation，WBC，neutrophil count，lymphocyte countand NLR are independent influencing factors of HT in patients with AMCI，thereinto NLR has relatively high predictive value onHT in patients with AMCI.

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