血小板淋巴细胞比值与急性缺血性卒中预后关系的研究进展
Research Progress on the Relationship between Platelet-to-Lymphocyte Ratio and Prognosis of Acute Ischemic Stroke
摘要: 急性大血管闭塞性卒中(AIS-LVO)致残率、致死率高，血管内血栓切除术(EVT)再通效果确切，但整体预后不理想。血小板糖蛋白IIb/IIIa受体拮抗剂替罗非班在EVT围术期可使部分患者获益，但疗效存在个体差异。血小板淋巴细胞比值(PLR)可反映血栓及炎症状态，在卒中预后评估中备受关注。本文就AIS-LVO治疗现状、替罗非班应用价值、PLR生物学基础及预后相关研究、延迟神经功能改善(DNI)等进行综述，为PLR预测接受替罗非班辅助EVT的AIS-LVO患者预后提供理论依据。
Abstract: Acute ischemic stroke with large vessel occlusion (AIS-LVO) has high disability and mortality rates. Endovascular thrombectomy (EVT) is effective for recanalization, but the overall prognosis is not satisfactory. Tirofiban, a platelet glycoprotein IIb/IIIa receptor antagonist, can benefit some patients during the perioperative period of EVT, but its efficacy varies among individuals. The platelet-to-lymphocyte ratio (PLR) reflects thrombotic and inflammatory status and has attracted wide attention in the prognostic evaluation of stroke. This article reviews the current treatment of AIS-LVO, the application value of tirofiban, the biological basis and prognostic research of PLR, and delayed neurological improvement (DNI), so as to provide a theoretical basis for PLR in predicting the prognosis of AIS-LVO patients treated with tirofiban-assisted EVT.
文章引用：王蛲雨, 王宇晗, 杨黔粤, 谢家祺, 宋敏. 血小板淋巴细胞比值与急性缺血性卒中预后关系的研究进展[J]. 临床医学进展, 2026, 16(5): 763-771. https://doi.org/10.12677/acm.2026.1651871

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] Goyal, M., Menon, B.K., van Zwam, W.H., Dippel, D.W.J., Mitchell, P.J., Demchuk, A.M., et al. (2016) Endovascular Thrombectomy after Large-Vessel Ischaemic Stroke: A Meta-Analysis of Individual Patient Data from Five Randomised Trials. The Lancet, 387, 1723-1731. [Google Scholar] [CrossRef] [PubMed]
[3] Majoie, C.B., Cavalcante, F., Gralla, J., Yang, P., Kaesmacher, J., Treurniet, K.M., et al. (2023) Value of Intravenous Thrombolysis in Endovascular Treatment for Large-Vessel Anterior Circulation Stroke: Individual Participant Data Meta-Analysis of Six Randomised Trials. The Lancet, 402, 965-974. [Google Scholar] [CrossRef] [PubMed]
[4] Guo, W., Xu, J., Ma, L., Ma, J., Li, S., Ren, C., et al. (2022) Safety and Efficacy of Different Tirofiban Administration Routes on Acute Ischemic Stroke Patients with Successful Recanalization: A Propensity Score Matching Analysis. CNS Neuroscience & Therapeutics, 28, 1993-2000. [Google Scholar] [CrossRef] [PubMed]
[5] Shuai, J., Gong, Z., Huang, L., Liu, J., Tang, K., Duan, Z., et al. (2022) Effect of Intravenous Tirofiban vs Placebo before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial. JAMA, 328, 543-553. [Google Scholar] [CrossRef] [PubMed]
[6] Yang, M., Huo, X., Miao, Z. and Wang, Y. (2019) Platelet Glycoprotein IIb/IIIa Receptor Inhibitor Tirofiban in Acute Ischemic Stroke. Drugs, 79, 515-529. [Google Scholar] [CrossRef] [PubMed]
[7] Liu, J., Yang, Y. and Liu, H. (2022) Efficacy Outcomes and Safety Measures of Intravenous Tirofiban or Eptifibatide for Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Prospective Studies. Journal of Thrombosis and Thrombolysis, 53, 898-910. [Google Scholar] [CrossRef] [PubMed]
[8] Iadecola, C. and Anrather, J. (2011) The Immunology of Stroke: From Mechanisms to Translation. Nature Medicine, 17, 796-808. [Google Scholar] [CrossRef] [PubMed]
[9] Koutsaliaris, I.K., Moschonas, I.C., Pechlivani, L.M., Tsouka, A.N. and Tselepis, A.D. (2022) Inflammation, Oxidative Stress, Vascular Aging and Atherosclerotic Ischemic Stroke. Current Medicinal Chemistry, 29, 5496-5509. [Google Scholar] [CrossRef] [PubMed]
[10] Couldwell, G. and Machlus, K.R. (2019) Modulation of Megakaryopoiesis and Platelet Production during Inflammation. Thrombosis Research, 179, 114-120. [Google Scholar] [CrossRef] [PubMed]
[11] Yan, J., Greer, J.M., Etherington, K., Cadigan, G.P., Cavanagh, H., Henderson, R.D., et al. (2009) Immune Activation in the Peripheral Blood of Patients with Acute Ischemic Stroke. Journal of Neuroimmunology, 206, 112-117. [Google Scholar] [CrossRef] [PubMed]
[12] Qiu, Z., Jiang, Y., Jiang, X., Yang, R., Wu, Y., Xu, Y., et al. (2020) Relationship between Platelet to Lymphocyte Ratio and Stable Coronary Artery Disease: Meta-Analysis of Observational Studies. Angiology, 71, 909-915. [Google Scholar] [CrossRef] [PubMed]
[13] Oylumlu, M., Yildiz, A., Oylumlu, M., Yuksel, M., Polat, N., Bilik, M.Z., et al. (2015) Platelet-to-lymphocyte Ratio Is a Predictor of In-Hospital Mortality Patients with Acute Coronary Syndrome. Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 15, 277-283. [Google Scholar] [CrossRef] [PubMed]
[14] Yayla, Ç., Akboga, M.K., Canpolat, U., Gayretli Yayla, K., Kuyumcu, M.S., Bayraktar, F., et al. (2015) The Association of the Platelet-To-Lymphocyte Ratio with Mitral Annular Calcification. Scandinavian Cardiovascular Journal, 49, 351-356. [Google Scholar] [CrossRef] [PubMed]
[15] Li, B., Zhou, P., Liu, Y., Wei, H., Yang, X., Chen, T., et al. (2018) Platelet-To-Lymphocyte Ratio in Advanced Cancer: Review and Meta-Analysis. Clinica Chimica Acta, 483, 48-56. [Google Scholar] [CrossRef] [PubMed]
[16] Zhang, Y., Zheng, L., Quan, L. and Du, L. (2021) Prognostic Role of Platelet‐To‐Lymphocyte Ratio in Oral Cancer: A Meta‐analysis. Journal of Oral Pathology & Medicine, 50, 274-279. [Google Scholar] [CrossRef] [PubMed]
[17] Gong, P., Liu, Y., Gong, Y., Chen, G., Zhang, X., Wang, S., et al. (2021) 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. Journal of Neuroinflammation, 18, Article No. 51. [Google Scholar] [CrossRef] [PubMed]
[18] Altintas, O., Altintas, M.O., Tasal, A., Kucukdagli, O.T. and Asil, T. (2016) The Relationship of Platelet-To-Lymphocyte Ratio with Clinical Outcome and Final Infarct Core in Acute Ischemic Stroke Patients Who Have Undergone Endovascular Therapy. Neurological Research, 38, 759-765. [Google Scholar] [CrossRef] [PubMed]
[19] Zhu, F., Wang, Z., Song, J. and Ji, Y. (2024) Correlation Analysis of Inflammatory Markers with the Short-Term Prognosis of Acute Ischaemic Stroke. Scientific Reports, 14, Article No. 17772. [Google Scholar] [CrossRef] [PubMed]
[20] Ferro, D., Matias, M., Neto, J., Dias, R., Moreira, G., Petersen, N., et al. (2021) Neutrophil-To-Lymphocyte Ratio Predicts Cerebral Edema and Clinical Worsening Early after Reperfusion Therapy in Stroke. Stroke, 52, 859-867. [Google Scholar] [CrossRef] [PubMed]
[21] Li, L., Chen, C., Chang, Y., Chen, Y., Lee, I. and How, C. (2021) Prognostic Role of Neutrophil-To-Lymphocyte Ratio, Platelet-To-Lymphocyte Ratio, and Systemic Immune Inflammation Index in Acute Ischemic Stroke: A STROBE-Compliant Retrospective Study. Medicine, 100, e26354. [Google Scholar] [CrossRef] [PubMed]
[22] Cai, H., Han, Y., Sun, W., Zha, M., Shi, X., Huang, K., et al. (2022) Delayed Neurological Improvement Is Predictive to Long-Term Clinical Outcome on Endovascular Thrombectomy Patients. Interventional Neuroradiology, 28, 404-410. [Google Scholar] [CrossRef] [PubMed]
[23] Powers, W.J., Rabinstein, A.A., Ackerson, T., Adeoye, O.M., Bambakidis, N.C., Becker, K., et al. (2019) Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 50, e344-e418. [Google Scholar] [CrossRef] [PubMed]
[24] Lin, L., Liu, F., Yi, T., Zhu, Y., Yang, J., Zhao, Y., et al. (2025) Tirofiban on First-Pass Recanalization in Acute Stroke Endovascular Thrombectomy. JAMA Network Open, 8, e255308. [Google Scholar] [CrossRef] [PubMed]
[25] Wang, L., Huang, J., Song, J., Yang, J., Li, L., Guo, C., et al. (2024) Association of Functional Outcomes between Intravenous Tirofiban and Endovascular Thrombectomy in Imaging-Screened Patients with Large Vessel Occlusion Stroke: A Secondary Analysis of Randomized Clinical Trial. International Journal of Surgery, 110, 5505-5517. [Google Scholar] [CrossRef] [PubMed]
[26] Gonçalves, O.R., Marinho Mendes Filho, F.d.S., Ribeiro, F.V., Dominici, S., Fukunaga, C.K., de Lima Gonçalves, N.M., et al. (2025) Efficacy and Safety of Intravenous Tirofiban in Patients with Acute Ischemic Stroke Due to Large Artery Atherosclerosis Undergoing Endovascular Thrombectomy: A Systematic Review and Meta-analysis. Clinical Neurology and Neurosurgery, 249, Article ID: 108727. [Google Scholar] [CrossRef] [PubMed]
[27] 郭莺. 血小板/淋巴细胞比值与老年急性缺血性脑卒中患者静脉溶栓后出血转化及近期预后的关系[J]. 神经损伤与功能重建, 2025, 20(9): 543-546.
[28] Tsalta-Mladenov, M.E. and Andonova, S.P. (2024) Peripheral Blood Cell Count Ratios as a Predictor of Poor Functional Outcome in Patients with Acute Ischemic Stroke. Neurological Research, 46, 213-219. [Google Scholar] [CrossRef] [PubMed]
[29] 徐国锋, 王艳. 血小板相关参数与急性缺血性卒中静脉溶栓远期预后的相关性: Meta分析[J]. 中国现代医生, 2023, 61(28): 64-69.
[30] Li, Y., Chen, K., Wang, L., Zhao, L., Lei, C., Gu, Y., et al. (2025) Values of Lymphocyte-Related Ratios in Predicting the Clinical Outcome of Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis Based on Different Etiologies. Frontiers in Neurology, 16, Article 1542889. [Google Scholar] [CrossRef] [PubMed]
[31] Sharma, D. and Bhaskar, S.M.M. (2022) Prognostic Role of the Platelet-Lymphocyte Ratio in Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy: A Meta-Analysis. Journal of Central Nervous System Disease, 14, 16 p. [Google Scholar] [CrossRef] [PubMed]
[32] Efe, E., Kocayigit, I., Turker, P., Murat, K., Erkan, A., Sedat, T., et al. (2016) Platelet-To-Lymphocyte Ratio but Not Neutrophil-To-Lymphocyte Ratio Predicts High On-Treatment Platelet Reactivity in Clopidogrel-Treated Patients with Acute Coronary Syndrome. Indian Journal of Pharmacology, 48, 355-359. [Google Scholar] [CrossRef] [PubMed]
[33] Talavera, B., Gómez-Vicente, B., Martínez-Galdámez, M., López-Cancio, E., García-Cabo, C., Castellanos, M., et al. (2021) Delayed Neurological Improvement after Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke. Stroke, 52, 2210-2217. [Google Scholar] [CrossRef] [PubMed]
[34] Chai, M., Gong, X., Li, M., Li, L., Guo, C., Yang, J., et al. (2025) Predictors of Delayed Neurological Improvement in Patients with Large Core Infarctions Undergoing Endovascular Treatment. Journal of NeuroInterventional Surgery, jnis-2025-023779. [Google Scholar] [CrossRef] [PubMed]
[35] Park, S., Kwon, B., Chang, J.Y., Song, Y., Lee, D.H., Ha, S.H., et al. (2025) Factors Associated with Delayed Neurologic Improvement after Complete Endovascular Reperfusion in Anterior and Posterior Ischemic Stroke. Frontiers in Neurology, 16, Article 1543743. [Google Scholar] [CrossRef] [PubMed]

为你推荐