Cui Yu, Cui Ling-Yun, Chi Xia, Wang Qi, Zhang Xian-Wen, Chen Hui-Sheng
Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China.
Department of Neurology, Postgraduate Training Base of Jinzhou Medical University in the General Hospital of Northern Theater Command, Shenyang, China.
PLoS One. 2025 Jul 3;20(7):e0322037. doi: 10.1371/journal.pone.0322037. eCollection 2025.
Remote ischemic conditioning (RIC) has been proven to improve neurologic function after stroke in RICAMIS trial. Aggravated thrombosis and inflammatory through interaction between platelet and immune cells affected the prognosis of stroke. We conducted an exploratory secondary analysis of RICAMIS to investigate whether platelet-to-neutrophil ratio (PNR) predicted efficacy of RIC in stroke.
Patients without protocol violation and with baseline blood routine examination from the full analysis set were included and divided into low PNR and high PNR subgroups. The primary outcome was 90-day excellent functional outcome defined as modified Rankin Scale score of 0-1. Compared with usual care alone, we investigated efficacy of RIC treatment in each PNR subgroup and their interaction.
Of 1679 patients, 360 were assigned to low PNR and 1319 into high PNR. Compared with usual care alone, RIC treatment was associated with higher likelihood of 90-day excellent functional outcome across PNR, but significantly different in low PNR (60.9% versus 50.3%, adjusted RD, 11.3%; 95% CI, 1.1% to 21.5%; P =0.03) and not significantly different in high PNR (70.8% versus 65.3%, adjusted RD, 3.9%; 95% CI, -1.2% to 8.9%; P =0.13). No significant interaction was found (P =0.96).
This study firstly investigated the association between PNR at admission and efficacy of RIC treatment in stroke. With respect to long-term functional outcomes, patients benefited from RIC treatment regardless of PNR, but the benefit increased when level of PNR at admission was lower. Trial registration ClinicalTrials.gov Identifier: NCT03740971.
在RICAMIS试验中，远程缺血预处理（RIC）已被证明可改善卒中后的神经功能。血小板与免疫细胞之间的相互作用导致血栓形成和炎症加重，影响了卒中的预后。我们对RICAMIS进行了探索性二次分析，以研究血小板与中性粒细胞比值（PNR）是否可预测RIC对卒中的疗效。
纳入全分析集中未违反方案且有基线血常规检查的患者，并分为低PNR和高PNR亚组。主要结局为90天良好功能结局，定义为改良Rankin量表评分为0 - 1分。与单纯常规治疗相比，我们研究了RIC治疗在各PNR亚组中的疗效及其相互作用。
1679例患者中，360例被分配至低PNR组，1319例被分配至高PNR组。与单纯常规治疗相比，RIC治疗在各PNR组中90天良好功能结局的可能性更高，但在低PNR组中有显著差异（60.9%对50.3%，调整后RD，11.3%；95%CI，1.1%至21.5%；P = 0.03），在高PNR组中无显著差异（70.8%对65.3%，调整后RD，3.9%；95%CI， - 1.2%至8.9%；P = 0.13）。未发现显著的相互作用（P = 0.96）。
本研究首次探讨了入院时PNR与RIC治疗卒中疗效之间的关联。就长期功能结局而言，无论PNR如何，患者均可从RIC治疗中获益，但入院时PNR水平较低时获益增加。试验注册ClinicalTrials.gov标识符：NCT03740971。
