Department of Neurology, The Fourth People's Hospital Affiliated to Tongji University, Shanghai, China.
Neurovascular Center, Department of Neurology, Changhai Hospital, Naval Medical University, Shanghai, China.
Clin Neurol Neurosurg. 2024 Apr;239:108228. doi: 10.1016/j.clineuro.2024.108228. Epub 2024 Mar 6.
To evaluate the correlation between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and intracranial atherosclerotic stenosis-related emergent large vessel occlusion (ICAS-ELVO) in acute ischemic stroke patients with endovascular thrombectomy.
Included in this study were 215 patients who underwent endovascular thrombectomy. They were randomly assigned to training and testing datasets. The patients in training dataset (n=128) were divided into ICAS group (n=65) and embolism group (n=63). MHR was compared between the two groups. According to the cut-off value, patients in testing dataset (n=87) were divided into low-MHR group (n=54) and high-MHR group (n=33). MHR was compared between the two groups.
In training dataset, the proportion of male patients, diabetic patients and smokers in ICAS group was significantly higher than that in embolism group [(50 (76.9%) vs. 30 (47.6%), P=0.001; 29 (44.6%) vs. 14(22.2%), P=0.007; 37(56.9%) vs. 14 (22.2%), P=0.001; 37 (56.9%) vs. 14 (22.2%), P=0.001], while the mean age and the proportion of patients with coronary heart disease (CHD), stroke and atrial fibrillation were significantly lower [(64.74±9.13 vs. 71.38±13.34, P=0.001; 6 (9.2%) vs. 14 (22.2%), P=0.043; 12 (18.5%) vs. 22 (34.9%), P=0.035; 5 (7.7%)vs. 56 (88.9%), P<0.001)]. The laboratory test results showed that monocyte count was significantly higher and high-density lipoprotein level was significantly lower in ICAS group than those in embolism group (0.61±0.26 vs. 0.45±0.13, P=0.001; 1.17±0.28 vs. 1.37±0.27, P=0.001). MHR in ICAS group was significantly higher than that in embolism group (0.55±0.26 vs. 0.34±0.11, P=0.001). In training set, MHR was found to be an independent predictor for the occurrence of ICAS-ELVO with an adjusted OR of 2.39 (95%CI 1.29-4.48, P=0.006). ROC curve analysis showed that the area under the curve (AUC) of MHR was 0.8 (95% CI, 0.72-0.87, p < 0.001), with a sensitivity of 0.60 and a specificity of 0.873. The optimal cut-off value of the MHR level was 0.46. In testing dataset, the rate of ICAS-ELVO in higher quartile was significantly higher than that in the lower quartile (81.8% vs. 33.3%, P<0.001). Patients with a low MHR had a higher rate of cerebral hemorrhagic than those with a high MHR.
MHR was associated with ICAS-ELVO in acute ischemic stroke patients with endovascular thrombectomy, and the higher level of MHR does benefit to differentiate ICAS from intracranial embolism, suggesting that MHR may prove to be an independent predictor for ICAS-ELVO.
评估单核细胞/高密度脂蛋白胆固醇比值（MHR）与血管内血栓切除术治疗的急性缺血性脑卒中患者颅内动脉粥样硬化性狭窄相关的大血管闭塞（ICAS-ELVO）之间的相关性。
纳入 215 名接受血管内血栓切除术的患者。他们被随机分配到训练和测试数据集。训练数据集（n=128）中的患者被分为 ICAS 组（n=65）和栓塞组（n=63）。比较两组间的 MHR。根据截断值，测试数据集（n=87）中的患者分为低 MHR 组（n=54）和高 MHR 组（n=33）。比较两组间的 MHR。
在训练数据集中，ICAS 组中男性患者、糖尿病患者和吸烟者的比例明显高于栓塞组[（50（76.9%）比 30（47.6%），P=0.001；29（44.6%）比 14（22.2%），P=0.007；37（56.9%）比 14（22.2%），P=0.001；37（56.9%）比 14（22.2%），P=0.001]，而平均年龄以及冠心病（CHD）、脑卒中、心房颤动患者的比例明显较低[（64.74±9.13 比 71.38±13.34，P=0.001；6（9.2%）比 14（22.2%），P=0.043；12（18.5%）比 22（34.9%），P=0.035；5（7.7%）比 56（88.9%），P<0.001]。实验室检查结果显示，ICAS 组的单核细胞计数明显高于栓塞组，高密度脂蛋白水平明显低于栓塞组[（0.61±0.26 比 0.45±0.13，P=0.001；1.17±0.28 比 1.37±0.27，P=0.001）。ICAS 组的 MHR 明显高于栓塞组[（0.55±0.26 比 0.34±0.11，P=0.001）。在训练集中，MHR 被发现是 ICAS-ELVO 发生的独立预测因子，调整后的 OR 为 2.39（95%CI 1.29-4.48，P=0.006）。ROC 曲线分析显示，MHR 的 AUC 为 0.8（95%CI，0.72-0.87，p<0.001），灵敏度为 0.60，特异性为 0.873。MHR 水平的最佳截断值为 0.46。在测试数据集中，较高四分位数的 ICAS-ELVO 发生率明显高于较低四分位数[81.8%比 33.3%，P<0.001）。MHR 较低的患者脑出血发生率较高。
MHR 与血管内血栓切除术治疗的急性缺血性脑卒中患者的 ICAS-ELVO 相关，较高的 MHR 水平有利于区分 ICAS 与颅内栓塞，提示 MHR 可能是 ICAS-ELVO 的独立预测因子。
