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血管内血栓切除术治疗前循环缺血性卒中患者的炎症和血小板体积标志物与临床结局的关系。

Association of inflammatory and platelet volume markers with clinical outcome in patients with anterior circulation ischaemic stroke after endovascular thrombectomy.

机构信息

Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Neurology, The Beijing Moslem People Hospital, Beijing, China.

出版信息

Neurol Res. 2021 Jun;43(6):503-510. doi: 10.1080/01616412.2020.1870359. Epub 2021 Jan 5.

Abstract

: To determine the correlation of inflammatory and platelet volume indices with the severity of stroke and 3-month clinical outcomes in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT).: A retrospective analysis was conducted for AIS patients who underwent EVT at our hospital from 2015 to 2019. Inflammatory factors, including white blood count, neutrophil count, lymphocyte count, neutrophil to lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT) and interleukin-6 (IL-6), and platelet volume indices, including platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and MPV/PC levels were assessed. Results were analyzed between patients with favorable and unfavorable outcomes at 3 months post-EVT.: A total of 257 AIS patients were included in the study. There were 86 (33.5%) patients with favorable functional outcomes at 3 months. Compared to patients with favorable outcomes, those with poor outcomes have lower lymphocyte count, higher neutrophil count and NLR levels. There were no differences in hs-CRP,PCT and IL-6 between the two groups. The correlation analysis showed that the increase in MPV, PDW, and MPV/PC was related to the high level of the NIHSS score at admission. Multivariate logistic regression analysis showed that higher NLR levels are an independent risk factor for unfavorable outcomes at 3 months (OR = 1.141; 95% CI 1.061 to 1.227,  = 0.000).: MPV, PDW, and MPV/PC are associated with stroke severity. Higher NLR levels upon admission may predict unfavorable functional outcomes in patients with AIS after undergoing EVT. ACA: anterior cerebral artery; AIS: acute ischemic stroke; ASPECTS: alberta stroke program early CT score; BMI: body mass index; DBP: diastolic blood pressure; END: early neurological deterioration; EVT: endovascular thrombectomy; hs-CRP: high-sensitivity C-reactive protein; HT: hemorrhagic transformation; ICA: internal carotid artery; IL-6: interleukin-6; IS: ischemic progression; LAA: Large-Artery Atherosclerosis; MCA: middle cerebral artery; MPV: mean platelet volume; mTICI: modified thrombolysis in cerebral infarction; NIHSS: National Institute of Health stroke scale; NLR: neutrophil to lymphocyte ratio; OTP: onset-to-puncture; PC: platelet count; PCT: procalcitonin; PDW: platelet distribution width; SBP: systolic blood pressure; sICH: symptomatic intracerebral hemorrhageWBC: white blood cell.

摘要

目的

探讨血管内治疗(EVT)后急性缺血性脑卒中(AIS)患者炎症和血小板体积指数与卒中严重程度及 3 个月临床结局的相关性。方法:回顾性分析 2015 年至 2019 年在我院行 EVT 的 AIS 患者。评估炎症因子(白细胞计数、中性粒细胞计数、淋巴细胞计数、中性粒细胞与淋巴细胞比值 NLR、高敏 C 反应蛋白 hs-CRP、降钙素原 PCT 和白细胞介素-6 IL-6)和血小板体积指数(血小板计数 PC、平均血小板体积 MPV、血小板分布宽度 PDW 和 MPV/PC 水平)。分析 EVT 后 3 个月预后良好和不良患者的结果。结果:共纳入 257 例 AIS 患者,其中 86 例(33.5%)患者 EVT 后 3 个月功能预后良好。与预后良好的患者相比,预后不良的患者淋巴细胞计数较低,中性粒细胞计数和 NLR 水平较高。两组 hs-CRP、PCT 和 IL-6 无差异。相关性分析表明,MPV、PDW 和 MPV/PC 的升高与入院时 NIHSS 评分较高有关。多因素 logistic 回归分析显示,较高的 NLR 水平是 EVT 后 3 个月不良结局的独立危险因素(OR=1.141;95%CI 1.061 至 1.227,P=0.000)。结论:MPV、PDW 和 MPV/PC 与卒中严重程度相关。入院时较高的 NLR 水平可能预示着 AIS 患者 EVT 后功能结局不良。

:ACA=大脑前动脉;AIS=急性缺血性脑卒中;ASPECTS=阿尔伯塔卒中项目早期 CT 评分;BMI=体重指数;DBP=舒张压;END=早期神经功能恶化;EVT=血管内血栓切除术;hs-CRP=高敏 C 反应蛋白;HT=出血转化;ICA=颈内动脉;IL-6=白细胞介素-6;IS=缺血进展;LAA=大动脉粥样硬化;MCA=大脑中动脉;MPV=平均血小板体积;mTICI=改良脑梗死溶栓;NIHSS=美国国立卫生研究院卒中量表;NLR=中性粒细胞与淋巴细胞比值;OTP=发病至穿刺;PC=血小板计数;PCT=降钙素原;PDW=血小板分布宽度;SBP=收缩压;sICH=症状性颅内出血;WBC=白细胞。

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