中性粒细胞与淋巴细胞比值在急性缺血性脑卒中再灌注治疗后预后中的作用：一项系统评价与Meta分析
Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis.
作者信息
Sharma Divyansh, Spring Kevin J, Bhaskar Sonu M M
机构信息
Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia.
出版信息
J Cent Nerv Syst Dis. 2022 Apr 22;14:11795735221092518. doi: 10.1177/11795735221092518. eCollection 2022.
BACKGROUND
Inflammation may mediate response to acute reperfusion therapy (RT) in acute cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory biomarker, may play an important role in acute ischaemic stroke (AIS) prognostication.
OBJECTIVE
This meta-analysis sought to examine the effect of NLR on functional outcomes, mortality and adverse outcomes in AIS patients receiving RT.
METHODS
Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane databases. Data were extracted using a standardised data sheet and meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR with clinical/safety outcomes after RT was conducted.
RESULTS
Thirty-five studies (n = 10 308) were identified for the systematic review with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was associated with good functional outcomes (GFOs), defined as 3-month modified Rankin scale (mRS) 0-2 (SMD = -.46; 95% CI = -.62 to -.29; P < .0001), mRS 0-1 (SMD = -.44; 95% CI = -.66 to -.22; P < .0001) and early neurological improvement (ENI) (SMD = -.55; 95 %CI = -.84 to -.25; P < .0001). Lower delayed admission NLR was also associated with GFOs (SMD = -.80; 95%CI = -.91 to -.68; P < .0001). Higher admission NLR was significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P = .009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P = .007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P < .0001). Higher delayed NLR was significantly associated with sICH (SMD = 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to 1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P < .0001). There were variations in outcomes across RT groups.
CONCLUSION
Higher admission or delayed NLR is significantly associated with worse morbidity, mortality and safety outcomes in AIS patients receiving RT.
背景
炎症可能介导急性脑缺血时对急性再灌注治疗（RT）的反应。中性粒细胞与淋巴细胞比值（NLR）作为一种炎症生物标志物，可能在急性缺血性卒中（AIS）的预后中发挥重要作用。
目的
本荟萃分析旨在研究NLR对接受RT的AIS患者功能结局、死亡率和不良结局的影响。
方法
从PubMed/Medline、EMBASE和Cochrane数据库中检索个体研究。使用标准化数据表提取数据，并对RT后入院时（RT前）或延迟时（RT后）NLR与临床/安全结局的相关性进行荟萃分析。
结果
共识别出35项研究（n = 10308）用于系统评价，其中27项（n = 8537）纳入荟萃分析。较低的入院时NLR与良好的功能结局（GFOs）相关，定义为3个月改良Rankin量表（mRS）评分为0 - 2（标准化均数差[SMD] = -0.46；95%置信区间[CI] = -0.62至 -0.29；P < 0.0001）、mRS评分为0 - 1（SMD = -0.44；95% CI = -0.66至 -0.22；P < 0.0001）以及早期神经功能改善（ENI）（SMD = -0.55；95% CI = -0.84至 -0.25；P < 0.0001）。较低的延迟入院时NLR也与GFOs相关（SMD = -0.80；95% CI = -0.91至 -0.68；P < 0.0001）。较高的入院时NLR与死亡率（SMD = 0.49；95% CI = 0.12至0.85；P = 0.009）、脑出血（ICH）（SMD = 0.34；95% CI = 0.09至0.59；P = 0.007）、症状性ICH（sICH）（SMD = 0.48；95% CI = 0.07至0.90；P = 0.022）以及卒中相关感染或肺炎（SMD = 0.85；95% CI = 0.50, 1.19；P < 0.0001）显著相关。较高的延迟NLR与sICH（SMD = 1.40；95% CI = 0.60至2.19；P = 0.001）、ICH（SMD = 0.94；95% CI = 0.41至1.46；P < 0.0001）和死亡率（SMD = 1.12；95% CI = 0.57至1.67；P < 0.0001）显著相关。不同RT组的结局存在差异。
结论
较高的入院时或延迟时NLR与接受RT的AIS患者更差的发病率、死亡率和安全结局显著相关。
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