Predictive value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet-to-neutrophil ratio in progressive ischemic stroke of large atherosclerosis
PANG Weiping1 WANG Baoai2
1.Fenyang College, Shanxi Medical University, Shanxi Province, Fenyang 032200, China; 2.Department of Neurology, Fenyang Hospital Fenyang Hospital Affiliated to Shanxi Medical University, Shanxi Province, Fenyang 032200, China
Abstract:Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR) and platelet-to-neutrophil ratio(PNR) in the progressive ischemic(PIS) stroke of large atherosclerosis. Methods Clinical data of 327 patients with large atherosclerotic cerebral infarction admitted to Fenyang Hospital of Shanxi Province from January 2021 to December 2021 were retrospectively collected. They were divided into PIS group (56 cases) and non-PIS group (271 cases) according to whether the disease progressed within 72 hours. Two sets of general data were compared and the influencing factors of PIS were explored and the predictive value of NLR, PLR, and PNR for PIS were evaluated. Results Admission systolic blood pressure, admission diastolic blood pressure, admission National Institutes of Health stroke scale (NIHSS) score, white blood cell count, neutrophil count, NLR, and PLR in PIS group were higher than those in non-PIS group, and lymphocyte count and PNR were lower than those in non-PIS group, with statistical significances (P<0.05). NLR (OR=1.150, 95%CI:1.048-1.261, P=0.003), PLR (OR=1.006, 95%CI:1.002-1.009, P= 0.002), and PNR (OR=0.978, 95%CI:0.958-0.997, P=0.024) were independent influencing factors of PIS. NLR predicted the area under receiver operating characteristic (ROC) curve of PIS was 0.707(95%CI:0.642-0.772, P<0.001), the optimal cutoff value was 3.14, the sensitivity was 82.1%, and the specificity was 61.6%. The area under curve of ROC PLR predicted PIS was 0.662(95%CI:0.589-0.736, P<0.001), the optimal cutoff value was 138.50, the sensitivity was 73.2%, and the specificity was 57.2%. The area under ROC curve of PNR predicted PIS was 0.604(95%CI:0.530-0.677, P=0.015), the best cutoff value was 44.28, the sensitivity was 64.3%, and the specificity was 59.4%. Conclusion NLR, PLR, and PNR are independent influencing factors of PIS, all of which have predictive value for progressive stroke of large atherosclerosis.
庞伟平1 王保爱2. 中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值和血小板与中性粒细胞比值对大动脉粥样硬化型进展性缺血性脑卒中的预测价值[J]. 中国医药导报, 2023, 20(32): 93-97.
PANG Weiping1 WANG Baoai2. Predictive value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet-to-neutrophil ratio in progressive ischemic stroke of large atherosclerosis. 中国医药导报, 2023, 20(32): 93-97.
[1] Sabir Rashid A,Huang-Link Y,Johnsson M,et al. Predictors of Early Neurological Deterioration and Functional Outcome in Acute Ischemic Stroke:The Importance of Large Artery Disease,Hyperglycemia and Inflammatory Blood Bio- markers [J]. Neuropsychiatr Dis Treat,2022,18:1993-2002. [2] Gong P,Xie Y,Jiang T,et al. Neutrophil-lymphocyte ratio predicts post-thrombolysis early neurological deterioration in acute ischemic stroke patients [J]. Brain Behav,2019,9(10): e01426. [3] Gong P,Liu Y,Gong Y,et al. The association of neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke [J]. J Neuroinflammation,2021,18(1):51. [4] Gao B,Pan W,Hu X,et al. Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis [J]. Front Physiol,2021,12:670323. [5] Pan H,Fu M,Ge W,et al. The effects of changes in platelet- to-neutrophil ratios 24 hours after intravenous thrombolysis on prognosis in acute ischemic stroke patients [J]. Clin Neurol Neurosurg,2020,190:105739. [6] Gao Z,Liu Q,Yang L,et al. Identification of high-risk factors for prehospital delay for patients with stroke using the risk matrix methods [J]. Front Public Health,2022,10:858926. [7] 彭斌,吴波.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682. [8] 吴方玲,胡金花,黄菊霞,等.颈动脉斑块超微血流成像联合颈动脉彩色多普勒血流成像血流动力学参数对进展性缺血性脑卒中的预测价值[J].中国医药导报,2023, 20(8):91-94. [9] Zhang X,Jia X,Chen L,et al. Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction [J]. Evid Based Complement Alternat Med,2022,2022:4521003. [10] Deuba K. Global burden of 369 diseases and injuries in 204 countries and territories,1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 [J]. Lancet,2020,396(10258):1204-1222. [11] Petrovic-Djergovic D,Goonewardena S,Pinsky D. Inflammatory Disequilibrium in Stroke [J]. Circ Res,2016,119(1):142-158. [12] Hill JW,Poddar R,Thompson J,et al. Intranuclear matrix metalloproteinases promote DNA damage and apoptosis induced by oxygen-glucose deprivation in neurons [J]. Neuroscience,2012,220:277-290. [13] Xie L,Roy Choudhury G,Winters A,et al. Cerebral regulatory T cells restrain microglia/macrophage-mediated inflammatory responses via IL-10:Immunomodulation [J]. Eur J Immunol,2015,45(1):180-191. [14] Park BJ,Shim JY,Lee HR,et al. Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score [J]. Clin Chim Acta,2011,412(11/12):925- 929. [15] Stoll G,Nieswandt B. Thrombo-inflammation in acute ischaemic stroke-implications for treatment [J]. Nat Rev Neurol,2019,15(8): 473-481. [16] Lattanzi S,Norata D,Broggi S,et al. Neutrophil-to-Lymphocyte Ratio Predicts Early Neurological Deterioration after Endovascular Treatment in Patients with Ischemic Stroke [J]. Life (Basel),2022,12(9): 1415. [17] Xu XR,Zhang D,Oswald BE,et al. Platelets are versatile cells: New discoveries in hemostasis,thrombosis,immune responses,tumor metastasis and beyond [J]. Crit Rev Clin Lab Sci,2016,53(6):409-430. [18] Geng L,Zuo L,Li H,et al. Association of platelet-to-neutrophil ratios with 1-year outcome and mortality in patients with acute ischemic stroke [J]. Neurosci Lett,2023,798:137016. [19] Jin P,Li X,Chen J,et al. Platelet-to-neutrophil ratio is a prognostic marker for 90-days outcome in acute ischemic stroke [J]. J Clin Neurosci,2019,63:110-115. [20] Long H,Qin K,Chen J,et al. Biomarkers of gastric cancer- related ischemic stroke and its underlying pathogenesis [J]. Medicine (Baltimore),2018,97(17):e0493. [21] Wang MQ,Sun YY,Wang Y,et al. Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke [J]. Curr Neurovasc Res,2020,17(4):411-419. [22] Piri Cinar B,Kunt R,Yuksel B,et al. Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort [J]. Int J Clin Pract,2021,75(4):e13955. [23] 杨红娜,冀瑞俊,于凯,等.急性脑梗死患者发生早期神经功能恶化的危险因素研究[J].实用心脑肺血管病杂志,2020,28(10):56-61. [24] 柘晓宁,余青龙,龙晓艳,等.血清N-myc下游调节基因2和雷帕霉素靶蛋白与急性缺血性脑卒中患者早期神经功能恶化的关系[J].中华实用诊断与治疗杂志,2022, 36(3):275-278. [25] 农媛,黄日玲,黄月琼.急性缺血性脑卒中患者静脉溶栓治疗后早期神经功能恶化的影响因素[J].中国医药科学,2022,12(22):122-125.