炎症标志物在不同TOAST病因亚型急性缺血性卒中中的预后价值
Prognostic Value of Inflammatory Markers across Different TOAST Etiologic Subtypes of Acute Ischemic Stroke
DOI: 10.12677/acm.2026.1641485, PDF,   
作者: 梁思媛*：延安大学医学院，陕西 延安；李 伟#：陕西省人民医院神经内二科，陕西 西安
关键词: 缺血性卒中；TOAST分型；炎症标志物；预后；Ischemic Stroke； TOAST Classification； Inflammatory Markers； Prognosis
摘要: 急性缺血性卒中(Acute Ischemic Stroke, AIS)是全球致残和致死的主要原因，炎症反应在其病理生理过程中发挥关键作用。近年来，基于外周血常规的复合炎症标志物如全身免疫炎症指数(Systemic Immune-inflammation Index, SII)、全身炎症反应指数(System Inflammation Response Index, SIRI)、单核细胞–高密度脂蛋白比值(Monocyte to High-density lipoproteins Ratio, MHR)、中性粒细胞–高密度脂蛋白比值(Neutrophil to High-density lipoproteins Ratio, NHR)及全身炎症聚合指数(Aggregate Index of Systemic Inflammation, AISI)等，因其简便、经济、可重复性强而受到广泛关注。然而，AIS是一种病因异质性疾病，不同TOAST病因分型具有不同的炎症病理生理基础，导致同一炎症标志物在不同亚型中的预后价值存在显著差异。本文系统综述了各TOAST分型的炎症病理生理特点，总结了不同炎症标志物在各亚型中的研究进展，并提出了不同TOAST病因分型中炎症标志物的预后价值，为临床精准评估AIS患者预后提供参考。
Abstract: Acute ischemic stroke (AIS) remains a leading cause of death and disability worldwide, with inflammation playing a pivotal role in its pathophysiology. In recent years, composite inflammatory markers derived from routine peripheral blood tests—such as the Systemic Immune-inflammation Index (SII), Systemic Inflammation Response Index (SIRI), Monocyte to High-density Lipoprotein Ratio (MHR), Neutrophil to High-density Lipoprotein Ratio (NHR), and Aggregate Index of Systemic Inflammation (AISI)—have garnered significant attention due to their simplicity, cost-effectiveness, and reproducibility. However, AIS is an etiologically heterogeneous disease. Different TOAST (Trial of Org 10,172 in Acute Stroke Treatment) subtypes possess distinct inflammatory pathophysiological mechanisms, leading to significant variability in the prognostic value of the same inflammatory marker across different subtypes. This review systematically examines the inflammatory pathophysiological characteristics of each TOAST subtype and synthesizes the current research progress on various inflammatory markers within these classifications. We propose an etiology-oriented strategy for marker selection, aiming to provide a reference for more precise prognostic assessment in patients with AIS.
文章引用：梁思媛, 李伟. 炎症标志物在不同TOAST病因亚型急性缺血性卒中中的预后价值[J]. 临床医学进展, 2026, 16(4): 2359-2368. https://doi.org/10.12677/acm.2026.1641485

参考文献

[1] Saini, V., Guada, L. and Yavagal, D.R. (2021) Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology, 97, S6-S16. [Google Scholar] [CrossRef] [PubMed]
[2] Iordache, M.P., Buliman, A., Costea-Firan, C., Gligore, T.C.I., Cazacu, I.S., Stoian, M., et al. (2025) Immunological and Inflammatory Biomarkers in the Prognosis, Prevention, and Treatment of Ischemic Stroke: A Review of a Decade of Advancement. International Journal of Molecular Sciences, 26, Article 7928. [Google Scholar] [CrossRef] 
[3] Ma, X., Zhou, Y., Li, Z., Mao, G., Wei, H. and Zhao, T. (2026) Comparison of the Predictive Performance of Systemic Immune-Inflammation Index and Neutrophil-to-Lymphocyte Ratio for Three-Month Poor Functional Outcome in Ischemic Stroke: A Systematic Review and Meta-Analysis. Annals of Medicine, 58, Article 2612820. [Google Scholar] [CrossRef] 
[4] Zhang, X., Xue, J., Yang, W., Xu, X., Sun, H., Hu, L., et al. (2020) Inflammatory Markers as Independent Predictors for Stroke Outcomes. Brain and Behavior, 11, e01922. [Google Scholar] [CrossRef] [PubMed]
[5] Karacan Gölen, M., Uçar Karabulut, K., Kamiloğlu, M. and Yonar, A. (2025) Pan‐Immune‐Inflammation Value Predicts 3‐Month Functional Outcomes in Patients with Acute Ischemic Stroke Treated with Mechanical Thrombectomy. Brain and Behavior, 15, e70397. [Google Scholar] [CrossRef] [PubMed]
[6] Feng, X., Yu, F., Wei, M., Luo, Y., Zhao, T., Liu, Z., et al. (2023) The Association between Neutrophil Counts and Neutrophil-to-Lymphocyte Ratio and Stress Hyperglycemia in Patients with Acute Ischemic Stroke According to Stroke Etiology. Frontiers in Endocrinology, 14, Article ID: 1117408. [Google Scholar] [CrossRef] [PubMed]
[7] Liu, K., Yang, L., Liu, Y., Zhang, Y., Zhu, J., Zhang, H., et al. (2025) Systemic Immune-Inflammation Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR): A Strong Predictor of Disease Severity in Large-Artery Atherosclerosis (LAA) Stroke Patients. Journal of Inflammation Research, 18, 195-202. [Google Scholar] [CrossRef] [PubMed]
[8] Ni, P., Shao, H., Zhang, Q., Chen, Q., Yu, N., Li, B., et al. (2025) Study on the Correlation between HSCRP/HDL-C Ratio and the Severity and Prognosis of Ischemic Stroke. Neurological Research, 48, 1-11. [Google Scholar] [CrossRef] [PubMed]
[9] Huang, C., Geng, J., Fan, J., Tian, B., Wang, K., Zhang, Y., et al. (2025) Atherogenic and Inflammatory Markers in Recent Small Subcortical Infarcts: Associations with Location, Morphology, and Short-Term Recurrence. Journal of Inflammation Research, 18, 5881-5893. [Google Scholar] [CrossRef] [PubMed]
[10] Fakhari, M.S., Poorsaadat, L., Almasi-Hashiani, A. and Ebrahimi-Monfared, M. (2024) Inflammatory Markers and Functional Outcome Score in Different Subgroups of Ischaemic Stroke: A Prospective Cohort Study. BMJ Neurology Open, 6, e000556. [Google Scholar] [CrossRef] [PubMed]
[11] Göçmen, A. and Gesoglu Demir, T. (2024) The Aggregate Index of Systemic Inflammation as a Predictor of Mortality in Stroke Patients. Cureus, 16, e64007. [Google Scholar] [CrossRef] [PubMed]
[12] Lee, M., Lee, E.J., Kim, R.O., Pyun, J., Joo, B., Kwon, K., et al. (2024) Systemic Immune-Inflammation Index as a Predictor of Early Stroke Progression/Recurrence in Acute Atherosclerotic Ischemic Stroke. Clinical Neurology and Neurosurgery, 238, Article 108182. [Google Scholar] [CrossRef] [PubMed]
[13] Yang, Y., Han, Y., Sun, W. and Zhang, Y. (2023) Increased Systemic Immune-Inflammation Index Predicts Hemorrhagic Transformation in Anterior Circulation Acute Ischemic Stroke Due to Large-Artery Atherosclerotic. International Journal of Neuroscience, 133, 629-635. [Google Scholar] [CrossRef] [PubMed]
[14] Meng, L., Feng, A. and Ding, Z. (2025) Predictive Value of Systemic Immune-Inflammation Index and Neutrophil to High-Density Lipoprotein Ratio in Acute Ischemic Stroke. International Journal of Neuroscience, 136, 452-457. [Google Scholar] [CrossRef] 
[15] Wang, N., Yang, Y., Qiu, B., Gao, Y., Wang, A., Xu, Q., et al. (2022) Correlation of the Systemic Immune-Inflammation Index with Short-and Long-Term Prognosis after Acute Ischemic Stroke. Aging, 14, 6567-6578. [Google Scholar] [CrossRef] [PubMed]
[16] Weng, Y., Zeng, T., Huang, H., Ren, J., Wang, J., Yang, C., et al. (2021) Systemic Immune-Inflammation Index Predicts 3-Month Functional Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Clinical Interventions in Aging, 16, 877-886. [Google Scholar] [CrossRef] [PubMed]
[17] Zhang, A., Zhu, Y., Liao, J., Wu, D., Yan, X., Chen, J., et al. (2025) The Association of Systemic Inflammatory Response Index and Neutrophil-to-High-Density Lipoprotein Ratio Mediated by Fasting Blood Glucose with 90-Day Prognosis in Acute Ischemic Stroke Patients. Neuroepidemiology, 59, 31-42. [Google Scholar] [CrossRef] [PubMed]
[18] Chu, M., Luo, Y., Wang, D., Liu, Y., Wang, D., Wang, Y., et al. (2023) Systemic Inflammation Response Index Predicts 3-Month Outcome in Patients with Mild Acute Ischemic Stroke Receiving Intravenous Thrombolysis. Frontiers in Neurology, 14, Article ID: 1095668. [Google Scholar] [CrossRef] [PubMed]
[19] Wang, H., Qiao, H., Zhang, X., Wu, P., Gao, Y., Liu, X., et al. (2025) Association between the Systemic Inflammatory Response Index and Acute Ischemic Stroke in Young People. Frontiers in Neurology, 16, Article ID: 1644963. [Google Scholar] [CrossRef] 
[20] Acar, B.A., Acar, T., Vatan, M.B., et al. (2022) Predictive Value of Systemic Immune-Inflammation index for Cerebral Reper-Fusion and Clinical Outcomes in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment. European Review for Medical and Pharmacological Sciences, 26, 5718-28.
[21] Chen, L., Zhang, L., Li, Y., Zhang, Q., Fang, Q. and Tang, X. (2024) Association of the Neutrophil-to-Lymphocyte Ratio with 90-Day Functional Outcomes in Patients with Acute Ischemic Stroke. Brain Sciences, 14, Article 250. [Google Scholar] [CrossRef] [PubMed]
[22] Zhu, F., Ji, Y., Song, J., Huang, G. and Zhang, Y. (2023) Correlations between NLR, NHR, and Clinicopathological Characteristics, and Prognosis of Acute Ischemic Stroke. Medicine, 102, e33957. [Google Scholar] [CrossRef] [PubMed]
[23] Yu, L., Ma, K., Hao, J. and Zhang, B. (2023) Neutrophil to High-Density Lipoprotein Cholesterol Ratio, a Novel Risk Factor Associated with Acute Ischemic Stroke. Medicine, 102, e34173. [Google Scholar] [CrossRef] [PubMed]
[24] Zhang, R., Jin, F., Zheng, L., Liao, T., Guan, G., Wang, J., et al. (2022) Neutrophil to High-Density Lipoprotein Ratio Is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke. Journal of Inflammation Research, 15, 6073-6085. [Google Scholar] [CrossRef] [PubMed]
[25] Li, Y., Chen, D., Sun, L., Chen, Z. and Quan, W. (2021) Monocyte/High-Density Lipoprotein Ratio Predicts the Prognosis of Large Artery Atherosclerosis Ischemic Stroke. Frontiers in Neurology, 12, Article ID: 769217. [Google Scholar] [CrossRef] [PubMed]
[26] Gkantzios, A., Tsiptsios, D., Karapepera, V., Karatzetzou, S., Kiamelidis, S., Vlotinou, P., et al. (2023) Monocyte to HDL and Neutrophil to HDL Ratios as Potential Ischemic Stroke Prognostic Biomarkers. Neurology International, 15, 301-317. [Google Scholar] [CrossRef] [PubMed]
[27] Zhang, L., Lyu, Q., Zhou, W., Li, X., Ni, Q., Jiang, S., et al. (2022) High Systemic Immune-Inflammation Index Is Associated with Carotid Plaque Vulnerability: New Findings Based on Carotid Ultrasound Imaging in Patients with Acute Ischemic Stroke. Frontiers in Neurology, 13, Article ID: 959531. [Google Scholar] [CrossRef] [PubMed]
[28] Omar, T., Karakayalı, M., Yesin, M., Alaydın, H.C., Karabağ, Y. and Gümüşdağ, A. (2021) Monocyte to High-Density Lipoprotein Cholesterol Ratio Is Associated with the Presence of Carotid Artery Disease in Acute Ischemic Stroke. Biomarkers in Medicine, 15, 489-495. [Google Scholar] [CrossRef] [PubMed]
[29] Meng, D., Li, Y., Ju, T., Huo, W. and Wang, M. (2023) Low MHR Is Associated with Hemorrhagic Transformation in Acute Large Artery Atherosclerosis Ischemic Stroke Patients with Intravenous Thrombolysis. Clinical and Applied Thrombosis/Hemostasis, 29, 1-7.
[30] Bolayir, A., Gokce, S.F., Cigdem, B., Bolayir, H.A., Yildiz, O.K., Bolayir, E., et al. (2018) Monocyte/High-Density Lipoprotein Ratio Predicts the Mortality in Ischemic Stroke Patients. Neurologia i Neurochirurgia Polska, 52, 150-155. [Google Scholar] [CrossRef] [PubMed]
[31] Yang, N., Hu, L. and Han, Y. (2023) The Association between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Clinical Prognosis of Acute Ischemic Stroke after Intravenous Thrombolysis Therapy. Medicine, 102, e35338. [Google Scholar] [CrossRef] [PubMed]
[32] Oh, S.W., Yi, H.J., Lee, D.H. and Sung, J.H. (2020) Prognostic Significance of Various Inflammation-Based Scores in Patients with Mechanical Thrombectomy for Acute Ischemic Stroke. World Neurosurgery, 141, e710-e717. [Google Scholar] [CrossRef] [PubMed]
[33] Zhou, Y., Yang, Q., Zhou, Z., Yang, X., Zheng, D., He, Z., et al. (2025) Systemic Immune-Inflammation Index Is Associated with Clinical Outcome of Acute Ischemic Stroke Patients after Intravenous Thrombolysis Treatment. PLOS ONE, 20, e0319920. [Google Scholar] [CrossRef] [PubMed]
[34] Wei, C., Xue, J., Zhou, X., Xia, X. and Li, X. (2023) Systemic Immune-Inflammation Index Is a Prognostic Predictor for Patients with Acute Ischemic Stroke Treated with Intravenous Thrombolysis. The Neurologist, 29, 22-30. [Google Scholar] [CrossRef] [PubMed]
[35] Li, J., Zhang, P., Chen, H., Wang, Y., Han, Y., Wang, C., et al. (2024) Elevated Systemic Inflammation Response Index Is Associated with Poor Outcomes in Minor Ischemic Stroke. Frontiers in Neurology, 15, Article ID: 1492224. [Google Scholar] [CrossRef] [PubMed]
[36] Lu, Y., Zhu, X., Xu, Y., Li, Y., Dai, Q. and Chang, X. (2025) Lower CALLY Index Levels Indicate Higher Poor Functional Outcome Risk in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy. Frontiers in Aging Neuroscience, 17, Article ID: 1587861. [Google Scholar] [CrossRef] [PubMed]
[37] Chen, S., Huang, W., Liu, Y., Chen, X., Ke, B., Shen, Q., et al. (2025) Changes in Immune‐Inflammation Status and Acute Ischemic Stroke Prognosis in Prospective Cohort. Annals of Clinical and Translational Neurology, Online Ahead of Print.
[38] Zhu, L., Jie, S., Wu, S., Chen, Q., Zhang, X., Yang, W., et al. (2025) Ineffective Recanalization and Complications in Patients with Acute Ischemic Stroke Receiving Endovascular Treatment: Predictive Value of the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index. Journal of Inflammation Research, 18, 14649-14661. [Google Scholar] [CrossRef] 
[39] Wang, W., Huang, H., Ma, Q. and Cao, K. (2025) Association of Systemic Inflammation Indexes with 90-Day Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Intravenous Thrombolysis. International Journal of General Medicine, 18, 6425-6441. [Google Scholar] [CrossRef] 
[40] Wang, Y., Wang, J., Tian, F., Peng, M., Ma, X., Zheng, D., et al. (2025) Systemic Immune-Inflammation Index as a Biomarker for Stroke Prognosis: Insights from a Multi-Time Point Analysis. Biomarkers in Medicine, 19, 697-705. [Google Scholar] [CrossRef] [PubMed]
[41] Cui, Z., Kuang, S., Yang, X., Wang, Y., Gu, S., Li, H., et al. (2023) Predictive Value of the Systemic Immune Inflammation (SII) Index for Stroke‐Associated Pneumonia. Brain and Behavior, 13, e3302.

为你推荐