Dai Zhengze, Li Rongrong, Zhao Nan, Han Yunfei, Wang Mengmeng, Zhang Shuai, Bai Yongjie, Li Zibao, Liang Meng, Xiao Lulu, Ma Minmin, Liu Xinfeng, Xu Gelin
1 Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
2 Department of Neurology, Nanjing Pukou Hospital, Nanjing, Jiangsu, China.
Angiology. 2019 Feb;70(2):160-165. doi: 10.1177/0003319718784805. Epub 2018 Jun 25.
The inflammatory response plays a vital role in the development of in-stent restenosis (ISR) after carotid angioplasty and stenting (CAS). The neutrophil to lymphocyte ratio (NLR) has been suggested as a sensitive inflammatory marker. We explored the association between NLR and ISR in CAS patients. A total of 427 patients who underwent CAS were enrolled. Neutrophil to lymphocyte ratio was measured before the procedure. Clinical examination and radiographic evaluation were performed at 6 months and annually after the procedure. In-stent restenosis was defined as ≥50% stenosis in the treated lesion. Cox regression was used to identify predictors of ISR after CAS. Of the 459 arteries (in 427 patients) with CAS, 72 (15.7%) were identified with ISR during a mean follow-up of 14.6 (19.1) months (range, 0.7-120.7 months). Increased NLR (≥2.13) was significantly related to ISR in patients with asymptomatic stenosis ( P = .001). However, significance was not observed in symptomatic stenosis. On multivariate analysis, baseline NLR ≥ 2.13 (hazard ratio [HR], 2.74; 95% confidence interval [CI], 1.46-5.14), smoking (HR, 1.99; 95% CI, 1.11-3.58), residual stenosis (HR, 1.12; 95% CI, 1.09-1.15), and baseline glucose level (HR, 1.01; 95% CI, 1.01-1.02) were associated with ISR. Elevated NLR may be a predictor of ISR after CAS for asymptomatic stenosis.
炎症反应在颈动脉血管成形术和支架置入术（CAS）后支架内再狭窄（ISR）的发生发展中起着至关重要的作用。中性粒细胞与淋巴细胞比值（NLR）被认为是一种敏感的炎症标志物。我们探讨了CAS患者中NLR与ISR之间的关联。共纳入427例行CAS的患者。在手术前测量中性粒细胞与淋巴细胞比值。在术后6个月及每年进行临床检查和影像学评估。支架内再狭窄定义为治疗病变处狭窄≥50%。采用Cox回归分析确定CAS后ISR的预测因素。在427例患者的459条接受CAS治疗的动脉中，在平均14.6（19.1）个月（范围0.7 - 120.7个月）的随访期间，72条（15.7%）被确定为发生ISR。在无症状狭窄患者中，NLR升高（≥2.13）与ISR显著相关（P = .001）。然而，在有症状狭窄患者中未观察到显著性。多因素分析显示，基线NLR≥2.13（风险比[HR]，2.74；95%置信区间[CI]，1.46 - 5.14）、吸烟（HR，1.99；95%CI，1.11 - 3.58）、残余狭窄（HR，1.12；95%CI，1.09 - 1.15）和基线血糖水平（HR，1.01；95%CI，1.01 - 1.02）与ISR相关。NLR升高可能是无症状狭窄患者CAS后ISR的一个预测因素。
