NLR及血小板标志物在急性脑梗死血管内治疗研究进展
Research Progress in the Endovascular Treatment of NLR and Platelet Markers in Acute Cerebral Infarction
摘要: 静脉溶栓作为急性脑梗死的首选治疗方式,因受治疗时间窗及溶栓不彻底等影响因素限制,导致部分患者预后不佳,故而血管内治疗或成为静脉溶栓的一种可行的补充或替代治疗方法。血管内治疗不仅能直观了解血栓堵塞情况,更能尽快挽救缺血半暗带从而改善急性脑梗死预后,具有良好的应用前景。血管内治疗后机体产生的一系列炎症应激反应是影响预后的重要因素,因此,探究常规且经济便捷的炎性因子既可预测急性脑梗死患者预后,亦是目前临床亟待解决的热点问题。本文主要从血管内治疗后炎性因子与患者预后之间的关联性以及急性脑梗死血管内治疗方式两个方面进行阐述。综上,研究血管内治疗与炎性因子相关性对急性脑梗死患者的治疗及预后具有重要意义。
Abstract: Intravenous thrombolysis is the preferred treatment for acute cerebral infarction. Due to the limitations of therapeutic time window and incomplete thrombolysis and other influential factors, some patients have poor prognosis. Therefore, endovascular therapy may become a feasible complementary or alternative therapy for intravenous thrombolysis. Endovascular therapy can not only intuitively understand the situation of thrombosis, but also save the ischemic penumbra as soon as possible to improve the prognosis of acute cerebral infarction, which has a good application prospect. A series of inflammatory stress responses produced by the body after endovascular therapy is an important factor affecting the prognosis. Therefore, exploring several conventional and economical and convenient inflammatory factors can not only predict the prognosis of patients with acute cerebral infarction, but also become a hot issue to be solved urgently in clinic. In this paper, the relationship between inflammatory factors and prognosis of patients after endovascular therapy and the way of endovascular therapy for acute cerebral infarction were discussed. In conclusion, the study of the correlation between endovascular therapy and inflammatory factors is of great significance for the treatment and prognosis of patients with acute cerebral infarction.
文章引用:冯一麟, 满荣勇. NLR及血小板标志物在急性脑梗死血管内治疗研究进展[J]. 临床医学进展, 2024, 14(4): 1495-1501. https://doi.org/10.12677/acm.2024.1441185

参考文献

[1] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 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.
[2] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022 [J]. 中华神经科杂志, 2022, 55(6): 565-580.
[3] Jian, Y., Zhao, L., Jia, B., Tong, X., Li, T., Wu, Y., Wang, X., Gao, Z., Gong, Y., Zhang, X., Wang, H., Zhang, R., Zhang, L., Miao, Z., Zhang, G. and ANGEL-ACT Study Group (2021) Direct versus Bridging Mechanical Thrombectomy in Elderly Patients with Acute Large Vessel Occlusion: A Multicenter Cohort Study. Clinical Interventions in Aging, 16, 1265-1274. [Google Scholar] [CrossRef
[4] Chamorro, Á. and Torres, F. (2022) Intra-Arterial Alteplase vs Placebo after Successful Thrombectomy and Functional Outcomes in Patients with Large Vessel Occlusion Acute Ischemic Stroke-Reply. JAMA, 327, 2456. [Google Scholar] [CrossRef] [PubMed]
[5] Watson, C.C.L., Feria, A., Chen, C.J. and Camacho, A. (2021) Outcomes and Complications of Endovascular Mechanical Thrombectomy in the Treatment of Acute Posterior Circulation Occlusions: A Systematic Review. World Neurosurgery, 145, 35-44. [Google Scholar] [CrossRef] [PubMed]
[6] 廖嘉川, 吴波. 急性缺血性脑卒中抽吸取栓的应用与研究进展[J]. 华西医学, 2022, 37(6): 921-925.
[7] Turk III, A.S., Siddiqui, A., Fifi, J.T., De Leacy, R.A., Fiorella, D.J., Gu, E., Levy, E.I., Snyder, K.V., Hanel, R.A., Aghaebrahim, A., Woodward, B.K., Hixson, H.R., Chaudry, M.I., Spiotta, A.M., Rai, A.T., Frei, D., Almandoz, J.E.D., Kelly, M., Arthur, A., Baxter, B., English, J., Linfante, I., Fargen, K.M. and Mocco, J. (2019) Aspiration Thrombectomy versus Stent Retriever Thrombectomy as First-Line Approach for Large Vessel Occlusion (COMPASS): A Multicentre, Randomised, Open Label, Blinded Outcome, Non-Inferiority Trial. Lancet, 393, 998-1008. [Google Scholar] [CrossRef
[8] Wang, G., Fang, B., Yu, X. and Li, Z. (2018) [Interpretation of 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke]. Chinese Critical Care Medicine, 30, 289-295.
[9] Rha, J.H. and Saver, J.L. (2007) The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis. Stroke, 38, 967-973. [Google Scholar] [CrossRef
[10] Shen, B., Liu, Q., Gu, Y., Wang, Y. and Zhang, Z. (2015) Efficacy and Safety Evaluation on Arterial Thrombolysis in Treating Acute Cerebral Infarction. Cell Biochemistry and Biophysics, 73, 297-304. [Google Scholar] [CrossRef] [PubMed]
[11] Baik, S.H., Jung, C., Kim, J.Y., Shin, D.W., Kim, B.J., Kang, J., Bae, H.J. and Kim, J.H. (2021) Local Intra-Arterial Thrombolysis during Mechanical Thrombectomy for Refractory Large-Vessel Occlusion: Adjunctive Chemical Enhancer of Thrombectomy. American Journal of Neuroradiology, 42, 1986-1992. [Google Scholar] [CrossRef
[12] Diprose, W.K., Wang, M.T.M., Ghate, K., Brew, S., Caldwell, J.R., McGuinness, B. and Barber, P.A. (2021) Adjunctive Intra-Arterial Thrombolysis in Endovascular Thrombectomy: A Systematic Review and Meta-Analysis. Neurology, 96, 1135-1143. [Google Scholar] [CrossRef
[13] 林浩, 朱庆斌, 倪小佳, 等. 中国神经血管手术防治卒中相关指南的系统评价[J]. 中国脑血管病杂志, 2018, 15(4): 169-176.
[14] Timaran, C.H., Mantese, V.A., Malas, M., Brown, O.W., Lal, B.K., Moore, W.S., Voeks, J.H., Brott, T.G. and CREST Investigators (2013) Differential Outcomes of Carotid Stenting and Endarterectomy Performed Exclusively by Vascular Surgeons in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Journal of Vascular Surgery, 57, 303-308. [Google Scholar] [CrossRef] [PubMed]
[15] Yang, B., Ma, Y., Wang, T., Chen, Y., Wang, Y., Zhao, Z., Chen, D., Wang, J., Xu, X., Luo, T., Hua, Y., Ling, F., Qureshi, A.I., Hong, B., Jiao, L. and RECas Trial Investigators (2021) Carotid Endarterectomy and Stenting in a Chinese Population: Safety Outcome of the Revascularization of Extracranial Carotid Artery Stenosis Trial. Translational Stroke Research, 12, 239-247. [Google Scholar] [CrossRef] [PubMed]
[16] Malas, M.B., Dakour-Aridi, H., Wang, G.J., Kashyap, V.S., Motaganahalli, R.L., Eldrup-Jorgensen, J., Cronenwett, J.L. and Schermerhorn, M.L. (2019) Transcarotid Artery Revascularization versus Transfemoral Carotid Artery Stenting in the Society for Vascular Surgery Vascular Quality Initiative. Journal of Vascular Surgery, 69, 92-103.E2. [Google Scholar] [CrossRef] [PubMed]
[17] Naazie, I.N., Cui, C.L., Osaghae, I., Murad, M.H., Schermerhorn, M. and Malas, M.B. (2020) A Systematic Review and Meta-Analysis of Transcarotid Artery Revascularization with Dynamic Flow Reversal versus Transfemoral Carotid Artery Stenting and Carotid Endarterectomy. Annals of Vascular Surgery, 69, 426-436. [Google Scholar] [CrossRef] [PubMed]
[18] 孙红, 李夏, 胡晓飞, 等. 外周血炎症指标与血栓弹力图参数在急性脑梗死患者中的临床应用[J]. 中国卫生检验杂志, 2021, 31(23): 2890-2893.
[19] Frangogiannis, N.G. (2014) The Inflammatory Response in Myocardial Injury, Repair, and Remodelling. Nature Reviews Cardiology, 11, 255-265. [Google Scholar] [CrossRef] [PubMed]
[20] Tokgoz, S., Keskin, S., Kayrak, M., Seyithanoglu, A. and Ogmegul, A. (2014) Is Neutrophil/Lymphocyte Ratio Predict to Short-Term Mortality in Acute Cerebral Infarct Independently from Infarct Volume? Journal of Stroke and Cerebrovascular Diseases, 23, 2163-2168. [Google Scholar] [CrossRef] [PubMed]
[21] Wang, C., Zhang, Q., Ji, M., Mang, J. and Xu, Z. (2021) Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. BMC Neurology, 21, Article No. 191. [Google Scholar] [CrossRef] [PubMed]
[22] 王美琴, 李东芳, 白波, 等. 炎症反应在脑梗死中的研究进展[J]. 中华临床医师杂志(电子版), 2019, 13(12): 947-951.
[23] Chung, D., Lee, K.O., Choi, J.W., Kim, N.K., Kim, O.J., Kim, S.H., Oh, S.H. and Kim, W.C. (2020) Blood Neutrophil/Lymphocyte Ratio Is Associated with Cerebral Large-Artery Atherosclerosis but Not with Cerebral Small-Vessel Disease. Frontiers in Neurology, 11, Article 1022. [Google Scholar] [CrossRef] [PubMed]
[24] Wang, L., Song, Q., Wang, C., Wu, S., Deng, L., Li, Y., Zheng, L. and Liu, M. (2019) Neutrophil to Lymphocyte Ratio Predicts Poor Outcomes after Acute Ischemic Stroke: A Cohort Study and Systematic Review. Journal of the Neurological Sciences, 406, Article ID: 116445. [Google Scholar] [CrossRef] [PubMed]
[25] 徐冬勤, 何斌, 刘强晖, 等. 外周血D-二聚体和中性粒细胞-淋巴细胞比值快速诊断急性脑梗死患者的价值[J]. 中华卫生应急电子杂志, 2020, 6(6): 345-349.
[26] Lux, D., Alakbarzade, V., Bridge, L., Clark, C.N., Clarke, B., Zhang, L., Khan, U. and Pereira, A.C. (2020) The Association of Neutrophil-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio with 3-Month Clinical Outcome after Mechanical Thrombectomy Following Stroke. Journal of Neuroinflammation, 17, Article No. 60. [Google Scholar] [CrossRef] [PubMed]
[27] Lattanzi, S., Norata, D., Broggi, S., Meletti, S., Świtońska, M., Sołmka, A. and Silvestrini, M. (2022) Neutrophil-to-Lymphocyte Ratio Predicts Early Neurological Deterioration after Endovascular Treatment in Patients with Ischemic Stroke. Life, 12, Article 1415. [Google Scholar] [CrossRef] [PubMed]
[28] Koupenova, M., Clancy, L., Corkrey, H.A. and Freedman, J.E. (2018) Circulating Platelets as Mediators of Immunity, Inflammation, and Thrombosis. Circulation Research, 122, 337-351. [Google Scholar] [CrossRef
[29] Hou, Y., Carrim, N., Wang, Y., Gallant, R.C., Marshall, A. and Ni, H. (2015) Platelets in Hemostasis and Thrombosis: Novel Mechanisms of Fibrinogen-Independent Platelet Aggregation and Fibronectin-Mediated Protein Wave of Hemostasis. The Journal of Biomedical Research, 29, 437-444. [Google Scholar] [CrossRef
[30] Franks, Z.G., Campbell, R.A., Weyrich, A.S. and Rondina, M.T. (2010) Platelet-Leukocyte Interactions Link Inflammatory and Thromboembolic Events in Ischemic Stroke. Annals of the New York Academy of Sciences, 1207, 11-17. [Google Scholar] [CrossRef] [PubMed]
[31] Liu, L., Chen, W., Zhou, H., Duan, W., Li, S., Huo, X., Xu, W., Huang, L., Zheng, H., Liu, J., Liu, H., Wei, Y., Xu, J., Wang, Y. and Chinese Stroke Association Stroke Council Guideline Writing Committee (2020) Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders: Executive Summary and 2019 Update of Clinical Management of Ischaemic Cerebrovascular Diseases. Stroke and Vascular Neurology, 5, 159-176. [Google Scholar] [CrossRef] [PubMed]
[32] Lee, S.H., Jang, M.U., Kim, Y., Park, S.Y., Kim, C., Kim, Y.J. and Sohn, J.H. (2021) The Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Reperfusion and Prognosis after Endovascular Treatment of Acute Ischemic Stroke. Journal of Personalized Medicine, 11, Article 696. [Google Scholar] [CrossRef] [PubMed]