Liao Junqi, Zhang Aimei, Cong Yujun, Peng Wanhui, Tang Xiaogang, Zhu Qing, Li Li, Li Yunze, Liu Yan, Jiang Hui, Chen Jingyi, Han Yang, Chen Zhaoyao, Li Wenlei, Zhu Yuan, Liu Hongquan, Wu Minghua
Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, 210029, People's Republic of China.
Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, People's Republic of China.
BMC Psychiatry. 2025 Sep 14;25(1):772. doi: 10.1186/s12888-025-07198-0.
The association of neutrophil-to-lymphocyte ratio (NLR) and depressive symptoms with stroke risk, mortality, and major adverse cardiovascular events (MACE) is currently unknown. This study aimed to investigate the effects of neutrophil-to-lymphocyte ratio (NLR) and depressive symptoms on stroke risk, mortality, and MACE in NHANES 2005-2018.
The National Health and Nutrition Examination Survey (NHANES) was conducted by the National Center for Health Statistics between 2005 and 2018, recruiting a nationally representative sample of participants aged 20 years and older. The NLR reflects inflammatory status and the Patient Health Questionnaire 9 (PHQ-9) indicates depressive symptoms. Independent and joint associations between NLR, depressive symptoms, and stroke and mortality were then examined, and relative risk was calculated using weight-based Cox regression analyses. Finally, mediation analysis was used to explore the indirect impact of the PHQ-9 score on stroke and mortality mediated through NLR.
NLR and depressive symptoms were positively associated with stroke risk (p < 0.05). Participants with higher NLR levels had an increased risk of all-cause mortality and MACE (HR, 1.406; 95% CI 1.261-1.567; HR, 1.927; 95% CI 1.518-2.447), while those with higher PHQ-9 score were associated with an elevated risk of all-cause mortality and MACE (HR, 1.762; 95% CI 1.516-2.047; HR, 1.755; 95% CI 1.396-2.206). In addition, joint analyses indicated that participants with PHQ-9 score ≥ 10 and high NLR levels had the highest risk of all-cause mortality and MACE (HR, 2.079; 95% CI 1.673-2.585; HR, 2.858, 95% CI 2.007-4.069). Specifically, participants with elevated NLR levels and moderate-severe depressive symptoms faced the greatest risk of mortality. Mediation analyses revealed that NLR partially mediated the association between PHQ-9 score and stroke risk, all-cause mortality, and MACE by0.6%, 5.9%, and 4.8%, respectively.
Our research indicates that elevated NLR levels and more severe depressive symptoms were associated with increased risk of stroke, all-cause mortality and MACE. In addition, NLR plays a mediation role in linking depressive symptoms to stroke, MACE, and all-cause mortality.
目前尚不清楚中性粒细胞与淋巴细胞比值（NLR）及抑郁症状与中风风险、死亡率和主要不良心血管事件（MACE）之间的关联。本研究旨在调查2005 - 2018年美国国家健康与营养检查调查（NHANES）中NLR和抑郁症状对中风风险、死亡率和MACE的影响。
美国国家卫生统计中心在2005年至2018年期间开展了美国国家健康与营养检查调查（NHANES），招募了具有全国代表性的20岁及以上参与者样本。NLR反映炎症状态，患者健康问卷9（PHQ - 9）表明抑郁症状。然后检查NLR、抑郁症状与中风和死亡率之间的独立及联合关联，并使用基于权重的Cox回归分析计算相对风险。最后，采用中介分析来探讨PHQ - 9评分通过NLR对中风和死亡率产生的间接影响。
NLR和抑郁症状与中风风险呈正相关（p < 0.05）。NLR水平较高的参与者全因死亡率和MACE风险增加（风险比[HR]，1.406；95%置信区间[CI] 1.261 - 1.567；HR，1.927；95% CI 1.518 - 2.447），而PHQ - 9评分较高的参与者全因死亡率和MACE风险升高（HR，1.762；95% CI 1.516 - 2.047；HR，1.755；95% CI 1.396 - 2.206）。此外，联合分析表明，PHQ - 9评分≥10且NLR水平高的参与者全因死亡率和MACE风险最高（HR，2.079；95% CI 1.673 - 2.585；HR，2.858，95% CI 2.
