發(fā)布時間：2018-04-14 01:10

  本文選題：中性粒細胞 + 淋巴細胞��； 參考：《鄭州大學》2017年碩士論文

【摘要】：研究背景和目的中性粒細胞與淋巴細胞比值(Neutrophil to Lymphocyte Ratio,NLR)作為一種新的炎性指標,其在冠心病、急性冠脈綜合癥等患者的預后作用已得到證實,其在急性卒中患者中的作用開始引起關注。因此本研究旨在探索NLR水平與急性腦梗死患者病情嚴重程度、病情進展、預后以及其相關危險因素的關聯(lián),進一步分析該比值對其預后的預測價值。方法連續(xù)納入2014年1月至2015年12月于鄭州大學第五附屬醫(yī)院神經(jīng)內(nèi)科住院的急性腦梗死患者344例,其中女91例,男253例。記錄入院時年齡、性別、既往病史、入院及住院72h內(nèi)美國國立衛(wèi)生研究院卒中量表(NIHSS)評分等資料,根據(jù)入院中性粒細胞數(shù)目(Neutrophil,N)與淋巴細胞數(shù)目(Lymphocyte,L)計算出NLR值。根據(jù)NIHSS評分,分為輕度腦梗死組(n=204例)和中重度腦梗死組(n=140例)。根據(jù)住院72h內(nèi)NIHSS評分變化,分為進展性腦梗死組(56例)和非進展性腦梗死組(288例)。根據(jù)出院3個月后改良Rankin量表評分結果,分為預后良好組(n=195例)和預后不良組(n=112例),采用Logistics回歸分析急性腦梗死嚴重程度、神經(jīng)功能惡化及預后不良的影響因素,并采用受試者工作特征(ROC)曲線評價入院NLR水平等對急性腦梗死患者預后不良的預測作用。結果(1)與未合并高血壓、心房纖顫以及首次腦梗死患者比較,急性腦梗死并發(fā)高血壓、心房纖顫以及復發(fā)性腦梗死患者入院NLR水平偏高(均P0.05)。(2)與輕度腦梗死組比較,中重度腦梗死組入院NLR水平偏高[2.87(2.21,5.29)比2.64(1.94,3.68),P0.05],在矯正年齡、冠心病病史、復發(fā)性腦梗死病史以及TOAST分型的影響后,NLR水平與入院腦梗死嚴重程度相關(OR:1.100,95%CI:1.015~1.192)。(3)與非進展性腦梗死比較,進展性腦梗死組入院NLR水平偏高[3.02(2.33,4.95)比2.70(1.97,4.06),P0.05],在矯正入院NIHSS評分、年齡、冠心病病史等的影響后,NLR水平不是早期神經(jīng)功能惡化的獨立預測因子(OR:1.065,95%CI:0.980~1.159)。(4)與預后良好組比較,預后不良組患者入院NLR水平均較高[3.66(2.62,7.91)比2.47(1.94,3.40),P0.05],在矯正年齡、入院NIHSS評分、復發(fā)性腦梗死的影響后,NLR水平是預后不良的獨立預測因子(OR:1.427,95%CI:1.247~1.634)。(5)進行ROC曲線分析發(fā)現(xiàn),入院時NLR水平對急性腦梗死患者預后不良的診斷界值為2.84,其敏感度為69.6%,特異度為64.6%,曲線下面積為0.711,預測價值優(yōu)于白細胞計數(shù)(WBC)、N及L(曲線下面積為:0.600,0.661,0.320)。結論(1)急性腦梗死合并高血壓、心房纖顫以及復發(fā)性腦梗死中NLR水平明顯升高,提示合并相關危險因素的急性腦梗死患者可能具有更高的炎癥狀態(tài)。(2)入院NLR水平能反應急性腦梗死患者病情嚴重程度,NLR水平越高,病情越嚴重。(3)入院時NLR水平對急性腦梗死預后有預測作用,NLR水平越高,提示預后不良的風險越大。其預測價值優(yōu)于WBC、N、L。
[Abstract]:Background and objective Neutrophil to Lymphocyte Ratiotrophil as a new inflammatory marker, its prognostic role in patients with coronary heart disease and acute coronary syndrome has been confirmed.Its role in acute stroke patients is beginning to attract attention.The purpose of this study was to explore the relationship between NLR level and severity, progression, prognosis and related risk factors in patients with acute cerebral infarction, and to further analyze the prognostic value of this ratio in patients with acute cerebral infarction.Methods from January 2014 to December 2015, 344 patients with acute cerebral infarction were admitted to Department of Neurology, Fifth affiliated Hospital of Zhengzhou University, including 91 women and 253 men.Age, sex, past medical history, and NIHSS scores were recorded at admission and 72 hours after admission. The NLR values were calculated according to the number of neutrophilic neutrophil (neutrophila) and lymphocyte count (Lymphocytette).According to NIHSS score, the patients were divided into mild cerebral infarction group (n = 204) and moderate and severe cerebral infarction group (n = 140).According to the changes of NIHSS score within 72 hours of hospitalization, the patients were divided into progressive cerebral infarction group (n = 56) and non-progressive cerebral infarction group (n = 288).According to the results of modified Rankin scale after 3 months of discharge, the patients were divided into good prognosis group (n = 195) and poor prognosis group (n = 112). Logistics regression analysis was used to analyze the factors affecting the severity of acute cerebral infarction, deterioration of nerve function and poor prognosis.The predictive effect of admission NLR level on the prognosis of patients with acute cerebral infarction was evaluated by using the operating characteristics of subjects.Results compared with the patients without hypertension, atrial fibrillation and first cerebral infarction, the patients with acute cerebral infarction complicated with hypertension, atrial fibrillation and recurrent cerebral infarction had higher NLR level in admission (all P 0.05, P < 0.05), compared with the patients with mild cerebral infarction, the patients with acute cerebral infarction complicated with hypertension, patients with atrial fibrillation and patients with recurrent cerebral infarction were compared with mild cerebral infarction group.The NLR level in patients with moderate and severe cerebral infarction was higher than that in patients with moderate and severe cerebral infarction (2.87 鹵2.21 鹵5.29) compared with 2.641.94 鹵3.68% (P0.05). After correction of age, history of coronary heart disease, history of recurrent cerebral infarction and TOAST classification, the level of NLR was correlated with the severity of cerebral infarction.The NLR level in progressive cerebral infarction group was higher than that in 2.701.97 鹵4.06% group [3.02 鹵2.33 鹵4.95]. After correction of admission NIHSS score, age, coronary heart disease history and so on, the level of NLR was not an independent predictor of early neurological deterioration.The NLR levels in patients with poor prognosis were significantly higher [3.66 鹵2.62 鹵7.91] than 2.471.94 鹵3.40% (P0.05). The ROC curve analysis showed that NLR level was an independent predictor of poor prognosis after correction age, admission NIHSS score and recurrent cerebral infarction (OR 1.42795: CI1.2471.634.1).At admission, the diagnostic threshold value of NLR level for poor prognosis of patients with acute cerebral infarction was 2.84, the sensitivity was 69.6, the specificity was 64.6, the area under the curve was 0.711, and the predictive value was better than that of white blood cell count (WBC).Conclusion (1) NLR levels in patients with acute cerebral infarction complicated with hypertension, atrial fibrillation and recurrent cerebral infarction were significantly increased.It is suggested that the NLR level in patients with acute cerebral infarction with associated risk factors may be higher than that in patients with acute cerebral infarction.) the higher the severity of acute cerebral infarction is, the higher the level of NLRs may be in patients with acute cerebral infarction.The more serious the condition is, the higher the NLR level is at admission to predict the prognosis of acute cerebral infarction, and the higher the level of NLR is, the higher the risk of poor prognosis is.Its predictive value is better than that of WBCN.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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