溶栓前中性粒细胞/血小板比值对急性缺血性脑卒中静脉溶栓后出血性转化的预测作用。

Predictive Role of Pre-Thrombolytic Neutrophil-Platelet Ratio on Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Ischemic Stroke.

机构信息

Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

School of Clinical Medicine, Southwest Medical University, Luzhou, China.

出版信息

Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296231223192. doi: 10.1177/10760296231223192.

DOI:10.1177/10760296231223192

PMID:38166411

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10768614/

Abstract

To investigate the predictive role of the neutrophil-platelet ratio (NPR) before intravenous thrombolysis (IVT) on hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS). AIS patients treated with IVT without endovascular therapy between June 2019 and February 2023 were included. Patients were divided into high NPR (>35) and low NPR (≤35) groups according to the optimal threshold NPR value for identifying high-risk patients before IVT. The baseline data and the incidence of HT and symptomatic intracranial hemorrhage (sICH) were compared between the two groups. The predictive role of the NPR and other related factors on HT after IVT was analyzed by multivariate logistic regression. A total of 247 patients were included, with an average age of 67.5 ± 12.4 years. Post-thrombolytic HT was observed in 18.6% of the patients, and post-thrombolytic sICH was observed in 1.2% of the patients. There were 69 patients in the high NPR group and 178 patients in the low NPR group. The incidence of HT in the high NPR group was significantly higher than that in the low NPR group (30.4% vs 16.3%, < .05). The incidence of sICH was significantly higher in the high NPR group than in the low NPR group (14.5% vs 1.7%, < .001). Multivariate logistic regression analysis showed that NPR > 35 was positively correlated with HT (odds ratio (OR) = 3.236, 95% confidence interval (CI): 1.481-7.068, = .003) and sICH (OR = 13.644, 95% CI: 2.392-77.833, = .003). A high NPR (>35) before IVT may be a predictor of HT in AIS patients. This finding may help clinicians make clinical decisions before IVT in AIS patients.

摘要

探讨急性缺血性脑卒中（AIS）患者静脉溶栓（IVT）前中性粒细胞/血小板比值（NPR）对出血性转化（HT）的预测作用。纳入 2019 年 6 月至 2023 年 2 月期间接受 IVT 治疗但未行血管内治疗的 AIS 患者。根据 IVT 前识别高危患者的最佳 NPR 值，将患者分为高 NPR（>35）和低 NPR（≤35）组。比较两组间的基线资料、HT 及症状性颅内出血（sICH）发生率。采用多因素 logistic 回归分析 NPR 及其他相关因素对 IVT 后 HT 的预测作用。共纳入 247 例患者，平均年龄 67.5±12.4 岁。患者中溶栓后 HT 发生率为 18.6%，溶栓后 sICH 发生率为 1.2%。高 NPR 组 69 例，低 NPR 组 178 例。高 NPR 组 HT 发生率显著高于低 NPR 组（30.4%比 16.3%， < .05）。高 NPR 组 sICH 发生率显著高于低 NPR 组（14.5%比 1.7%， < .001）。多因素 logistic 回归分析显示，NPR>35 与 HT（比值比（OR）=3.236，95%置信区间（CI）：1.481-7.068， = .003）和 sICH（OR=13.644，95%CI：2.392-77.833， = .003）均呈正相关。IVT 前高 NPR（>35）可能是 AIS 患者 HT 的预测因素。这一发现可能有助于临床医生在 AIS 患者 IVT 前做出临床决策。