进展性缺血性脑卒中早期神经功能恶化的危险因素分析及NLR、SII预测作用

Analysis of Risk Factors for Early Deterioration of Neurological Function in Progressive Ischemic Stroke and the Predictive Role of NLR and SII

摘要: 目的：探讨进展性缺血性脑卒中早期神经功能恶化的相关危险因素，并分析中性粒细胞/淋巴细胞比值(NLR)、全身免疫炎症指数(SII)的预测价值。方法：回顾性收集2024年10月~2025年11月于济宁市中西医结合医院脑病科住院治疗的148例急性缺血性脑卒中患者。根据发病7天内NIHSS评分较基线增加≥2分或运动项评分增加≥1分，分为进展性卒中组和非进展性卒中组。比较两组患者的基线资料，并采用多因素Logistic回归分析影响早期神经功能恶化的独立相关因素，应用受试者工作特征(ROC)曲线分析NLR、SII及二者联合对进展性卒中发生的预测价值。结果：在148例急性缺血性卒中患者中，发生进展性脑卒中神经功能恶化者42例，未发生者106例。单因素分析表明：进展性脑卒中神经功能恶化组糖尿病(DM)病史、美国国立卫生研究院卒中量表(NIHSS)评分、中性粒细胞/淋巴细胞比值(NLR)、全身免疫炎症指数(SII)高于非恶化组，差异具有统计学意义(p < 0.05)。多因素Logistic回归表明：DM (OR = 2.413, 95% CI: 1.119~5.201, p < 0.05)、NLR (OR = 1.186, 95% CI: 1.042~1.350, p < 0.05)、SII (OR = 1.001, 95% CI: 1.000~1.002, p < 0.05)是急性缺血性卒中患者发生进展性脑卒中神经功能恶化的独立危险因素。ROC曲线分析显示：NLR预测进展性脑卒中神经功能恶化的曲线下面积(AUC)为0.642，最佳截断值为3.15，敏感度为71.4%，特异度为58.5%；SII预测的AUC为0.616，最佳截断值为551.07，敏感度为66.7%，特异度为55.7%；NLR联合SII预测的AUC为0.698，敏感度为76.2%，特异度为62.3%。NLR联合SII的预测价值高于单一指标。结论：糖尿病病史、NLR、SII是进展性缺血性脑卒中早期神经功能恶化的独立危险因素，NLR与SII联合检测可提高预测价值，值得临床关注。

Abstract: Objective: To explore the related risk factors for early deterioration of neurological function in acute ischemic stroke, and to analyze the predictive value of neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII). Method: A retrospective collection was conducted on 148 patients with acute ischemic stroke admitted to the Brain Disease Department of Jining Hospital of Traditional Chinese and Western Medicine from October 2024 to November 2025. Based on whether the NIHSS score increased by ≥2 points from baseline or whether the exercise score increased by ≥1 point from baseline within 7 days of onset, they were divided into a progressive stroke group and a non-progressive stroke group. Single factor analysis was used to analyze the baseline data of the two groups of patients, and multiple logistic regression analysis was used to analyze the independent factors affecting early deterioration of neurological function. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR, SII, and their combination for the occurrence of progressive stroke. Result: Among 148 patients with acute ischemic stroke, 42 experienced neurological deterioration in progressive ischemic stroke and 106 did not. Univariate analysis showed that the history of diabetes (DM), NIHSS score, neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammatory index (SII) in the neurological deterioration group were significantly higher than those in the non-deterioration group (p < 0.05). Multivariate logistic regression showed that DM (OR = 2.413, 95% CI: 1.119~5.201, p < 0.05), NLR (OR = 1.186, 95% CI: 1.042~1.350, p < 0.05), SII (OR = 1.001, 95% CI: 1.000~1.002, p < 0.05) were independent risk factors for neurological deterioration in progressive ischemic stroke. ROC curve analysis showed that NLR had an AUC of 0.642, with an optimal cutoff value of 3.15, a sensitivity of 71.4%, and a specificity of 58.5%; SII had an AUC of 0.616, with an optimal cutoff value of 551.07, a sensitivity of 66.7%, and a specificity of 55.7%; the combination of NLR and SII had an AUC of 0.698, with a sensitivity of 76.2%, and a specificity of 62.3%. The combined model showed higher predictive value than either single marker. Conclusion: The history of diabetes, NLR, and SII are independent risk factors for neurological deterioration in progressive ischemic stroke. The combination of NLR and SII can improve the predictive value and deserves clinical attention.