Huang Weiquan, Liao Libin, Liu Qian, Ma Rongchao, Hu Wentong, Dai Yuan, Wang Luna, Sha Dujuan
Department of General Practice, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of General Practice, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, China.
Front Neurol. 2025 Apr 24;16:1565613. doi: 10.3389/fneur.2025.1565613. eCollection 2025.
Stroke ranks as the second leading cause of mortality and the third leading cause of disability globally. Post-stroke cognitive impairment (PSCI) is a prevalent complication following acute ischemic stroke, imposing substantial burdens on patients, families, and society. This study aimed to explore the potential of circulating immune-inflammatory markers as predictors of PSCI.
Conducted as a prospective observational cohort study from June 2023 to August 2024 at the Affiliated Drum Tower Hospital, Medical School of Nanjing University, it included patients experiencing their first acute ischemic stroke within 72 h of symptom onset. Cognitive assessments were conducted 7 to 10 days post-stroke using the Montreal Cognitive Assessment (MoCA), with scores below 23 indicating PSCI.
A total of 146 patients meeting the inclusion criteria were recruited, with 71 patients exhibiting PSCI during the acute phase of stroke. Compared to patients in the post-stroke no cognitive impairment (PSNCI) group, those with PSCI demonstrated significantly elevated peripheral blood neutrophil-to-lymphocyte ratio (NLR), globulin-to-lymphocyte ratio (GLR), and C-reactive protein-to-lymphocyte ratio (CLR), while the lymphocyte-to-monocyte ratio (LMR) was notably reduced (all < 0.05). Both univariate and multivariate logistic regression analyses identified GLR as independently associated with PSCI. After adjusting for common clinical variables, the odds ratio (OR) for the highest tertile of GLR compared to the lowest was 6.20 (95% CI, 2.10-18.33; = 0.001). The optimal GLR cutoff was 18.22, with a sensitivity of 62.0%, specificity of 78.7%, and an area under curve (AUC) of 0.726.
This study indicates that elevated circulating GLR levels during the acute phase post-stroke onset are an independent risk factor for early-onset PSCI, even after adjusting for clinically relevant variables.
中风是全球第二大致死原因和第三大致残原因。中风后认知障碍（PSCI）是急性缺血性中风后常见的并发症，给患者、家庭和社会带来沉重负担。本研究旨在探讨循环免疫炎症标志物作为PSCI预测指标的潜力。
本研究为前瞻性观察队列研究，于2023年6月至2024年8月在南京大学医学院附属鼓楼医院进行，纳入症状发作72小时内首次发生急性缺血性中风的患者。中风后7至10天使用蒙特利尔认知评估量表（MoCA）进行认知评估，得分低于23分表明存在PSCI。
共招募了146名符合纳入标准的患者，其中71名患者在中风急性期出现PSCI。与中风后无认知障碍（PSNCI）组患者相比，PSCI患者外周血中性粒细胞与淋巴细胞比值（NLR）、球蛋白与淋巴细胞比值（GLR）和C反应蛋白与淋巴细胞比值（CLR）显著升高，而淋巴细胞与单核细胞比值（LMR）显著降低（均P<0.05）。单因素和多因素逻辑回归分析均确定GLR与PSCI独立相关。在调整常见临床变量后，GLR最高三分位数与最低三分位数相比的比值比（OR）为6.20（95%CI，2.10 - 18.33；P = 0.001）。GLR的最佳截断值为18.22，敏感性为62.0%，特异性为78.7%，曲线下面积（AUC）为0.726。
本研究表明，中风发作后急性期循环GLR水平升高是早发性PSCI的独立危险因素，即使在调整临床相关变量后亦是如此。
