中性粒细胞与淋巴细胞比值的变化与不同TOAST分型急性缺血性卒中患者溶栓后出血转化及早期神经功能改善的关系
The Correlation between the Neutrophil-to-Lymphocyte Ratio and Hemorrhagic Transformation as Well as Early Neurological Improvement Following Thrombolysis in Acute Ischemic Stroke Patients with Diverse TOAST Classifications
摘要: 目的：近年来研究发现中性粒细胞与淋巴细胞比值可以预测急性缺血性卒中(AIS)患者的短期和长期预后。但其变化量(ΔNLR)与患者溶栓后24 h的出血转化(HT)及早期神经功能改善(ENI)的关系仍缺乏研究。本次研究旨在探讨ΔNLR与溶栓后24 h的HT和ENI的关系，及ΔNLR与不同TOAST分型的患者溶栓后早期结局的关系。方法：纳入接受静脉溶栓治疗的AIS患者234例。对患者进行TOAST分型。根据HT和ENI的有无将患者进行分组。结果：发生HT的患者溶栓后NLR升高更明显，出现ENI的患者溶栓后NLR降低更明显。动脉粥样硬化型与心源性栓塞型患者的ΔNLR无明显差异，但小动脉闭塞型患者与大动脉粥样硬化型轻型患者相比，ΔNLR有统计学差异。结论：ΔNLR是AIS患者溶栓后HT和ENI的独立影响因素，且小动脉闭塞型脑卒中患者的ΔNLR大于轻型大动脉粥样硬化型脑卒中患者的ΔNLR。
Abstract: Objective: Recent studies have shown that the neutrophil-to-lymphocyte ratio can predict the short- and long-term prognosis of patients with acute ischemic stroke (AIS). However, the association between the variation of neutrophil-to- lymphocyte ratio(ΔNLR) and the bleeding transformation (HT) as well as early neurological improvement (ENI) at 24 h after thrombolysis is still lacking. The purpose of the study was to investigate the correlation between ΔNLR and HT as well as ENI 24 h after thrombolytic therapy, and the relationship between ΔNLR and early outcomes after thrombolytic therapy in patients with different TOAST classifications. Methods: 234 patients with AIS who received intravenous thrombolysis were included. The patients were classified by TOAST classifications. Patients were grouped according to the presence or absence of HT and ENI. Results: The increase of NLR after thrombolysis was more obvious in patients with HT while the decrease of NLR was more obvious in patients with ENI. There was no significant difference in ΔNLR between patients with atherosclerotic type and those with cardiogenic embolization type, but there was a statistical difference in ΔNLR between patients with small artery occlusion type and those with large artery atherosclerosis mild type. Conclusion: ΔNLR was an independent influencing factor for HT and ENI in AIS patients after thrombolysis, and ΔNLR in small artery occlusive stroke patients was greater than that in patients of minor stroke of LAA group.
文章引用：付欣怡, 马爱军. 中性粒细胞与淋巴细胞比值的变化与不同TOAST分型急性缺血性卒中患者溶栓后出血转化及早期神经功能改善的关系[J]. 临床医学进展, 2025, 15(1): 2079-2093. https://doi.org/10.12677/acm.2025.151275

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