外周血Hcy、D-D、NLR结合PLR对急性脑梗死溶栓治疗后复发的预测价值

doi:10.3969/j.issn.1004-583X.2025.03.004

摘要/Abstract

摘要：

目的分析外周血同型半胱氨酸(homocysteine,Hcy)、D-二聚体(D-dimer,D-D)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)结合血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)对急性脑梗死溶栓治疗后复发的预测价值。方法选取2020年3月-2022年3月周口市中心医院收治的急性脑梗死患者367例,均行静脉溶栓治疗;出院后随访1年,根据患者脑梗死有无复发将其分为复发组和未复发组,比较两组入院次日外周血Hcy、D-D、NLR、PLR及其他临床资料;采用logistic回归分析法分析急性脑梗死溶栓治疗后复发的影响因素,另采用受试者工作特征曲线分析外周血Hcy、D-D、NLR、PLR单项及联合对急性脑梗死溶栓治疗后复发的预测价值。结果复发组的高血压患者占比、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)水平、Hcy水平、D-D水平、NLR、PLR均高于未复发组(P<0.05);高血压、LDL-C、Hcy、D-D、NLR及PLR均为急性脑梗死溶栓治疗后复发的影响因素(P<0.05);外周血Hcy、D-D、NLR、PLR联合预测急性脑梗死溶栓治疗后复发的敏感度和曲线下面积高于单独预测(P<0.05),特异度与单独预测差异无统计学意义(P>0.05)。结论外周血LDL-C、Hcy、D-D、NLR、PLR均为急性脑梗死溶栓治疗后复发的影响因素,并对脑梗死复发具有一定的预测价值,且上述指标联合预测的效能更高。

关键词: 脑梗死, 同型半胱氨酸, D-二聚体, 中性粒细胞与淋巴细胞比值, 血小板与淋巴细胞比值, 静脉溶栓, 预测价值

Abstract:

Objective To analyze the predictive value of a combination of peripheral blood homocysteine (Hcy), D-dimer (D-D), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the recurrence of acute cerebral infarction(ACI) after a thrombolytic therapy. Methods A total of 367 patients with ACI admitted to Zhoukou Central Hospital from March 2020 to March 2022 were selected, and all patients underwent intravenous thrombolysis treatment. Following a 1-year follow-up after discharge, the patients were divided into the recurrent group and non-recurrent group based on the presence or absence of recurrent cerebral infarction. Peripheral Hcy, D-D, NLR, and PLR, and other clinical data on the other day of admission were compared between the two groups. The influencing factors for the recurrence of ACI after a thrombolytic therapy were analyzed using logistic regression analysis. The predictive value of single indicator and a combination of peripheral Hcy, D-D, NLR and PLR in the recurrence of ACI after a thrombolytic therapy was analyzed using the receiver operating characteristic (ROC) curve. Results The proportion of hypertension patients, low density lipoprotein-cholesterol (LDL-C) level, Hcy, D-D, NLR and PLR in the recurrent group were significantly higher than those of the non-recurrent group (P<0.05). Hypertension, LDL-C, Hcy, D-D, NLR and PLR were influencing factors for the recurrence of ACI after a thrombolytic therapy (P<0.05). The sensitivity and area under curve (AUC) of the combination of peripheral Hcy, D-D, NLR and PLR in predicting the recurrence of ACI after a thrombolytic therapy were significantly greater than the single indicator (P<0.05). The specificity was comparable between a single detection and combination (P>0.05). Conclusion Peripheral LDL-C, Hcy, D-D, NLR and PLR are influencing factors for the recurrence of ACI after a thrombolytic therapy, and they have certain predictive value for the recurrence of ACI. Their combination has a higher efficiency in predicting the recurrence of ACI after a thrombolytic therapy.

Key words: brain infarction, homocysteine, D-dimer, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, intravenous thrombolysis, predictive value

中图分类号:

R743.33

李芳芳, 刘亚首, 夏磊. 外周血Hcy、D-D、NLR结合PLR对急性脑梗死溶栓治疗后复发的预测价值[J]. 临床荟萃, 2025, 40(3): 217-221.

Li Fangfang, Liu Yashou, Xia Lei. Potential of a combination of peripheral Hcy, D-D, NLR and PLR in predicting the recurrence of acute cerebral infarction after a thrombolytic therapy[J]. Clinical Focus, 2025, 40(3): 217-221.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.03.004

https://lchc.magtechjournal.com/CN/Y2025/V40/I3/217

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参考文献 20

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组别	例数	年龄(岁)		男性[例(%)]		BMI(kg/m²)		吸烟史[例(%)]		饮酒史[例(%)]
复发组	56	60.52±10.12		33(58.9)		22.95±3.72		24(42.9)		22(39.3)
未复发组	296	58.74±9.48		158(53.4)		22.57±3.49		118(39.9)		110(37.2)
统计值		t=1.275		χ²=0.584		t=0.739		χ²=0.175		χ²=0.091
P值		0.203		0.445		0.460		0.676		0.763
组别	高血压 [例(%)]		TOAST分型[例(%)]
组别	高血压 [例(%)]		大动脉粥样硬化性		心源性脑栓塞		小动脉闭塞性		其他病因		不明原因
复发组	20(35.7)		23(41.1)		5(8.9)		24(42.9)		2(3.6)		2(3.6)
未复发组	89(30.1)		101(34.1)		26(8.8)		143(48.3)		15(5.1)		11(3.7)
统计值	χ²=7.019		χ²=1.091
P值	0.008		0.896
组别	FBG(mmol/L)		WBC(×10⁹/L)		PLT(×10⁹/L)		TC(mmol/L)		LDL-C(mmol/L)		HDL-C(mmol/L)
复发组	5.70±1.09		10.02±1.91		223.41±40.68		4.80±0.95		2.96±0.57		1.12±0.20
未复发组	5.47±1.04		9.54±1.88		215.39±37.43		4.68±0.93		2.75±0.54		1.16±0.22
统计值	t=1.506		t=1.748		t=1.450		t=0.882		t=2.645		t=1.265
P值	0.133		0.081		0.148		0.378		0.009		0.207
组别	TG(mmol/L)		UA(μmol/L)		Hcy(μmol/L)		D-D(mg/L)		NLR		PLR
复发组	1.45±0.28		302.65±58.60		15.89±2.43		0.51±0.08		3.64±0.65		133.62±20.31
未复发组	1.42±0.26		295.74±56.14		14.19±2.44		0.44±0.08		2.90±0.50		117.97±19.66
统计值	t=0.782		t=0.475		t=4.784		t=6.004		t=9.647		t=5.434
P值	0.435		0.635		<0.001		<0.001		<0.001		<0.001

组别	例数	年龄(岁)		男性[例(%)]		BMI(kg/m²)		吸烟史[例(%)]		饮酒史[例(%)]
复发组	56	60.52±10.12		33(58.9)		22.95±3.72		24(42.9)		22(39.3)
未复发组	296	58.74±9.48		158(53.4)		22.57±3.49		118(39.9)		110(37.2)
统计值		t=1.275		χ²=0.584		t=0.739		χ²=0.175		χ²=0.091
P值		0.203		0.445		0.460		0.676		0.763
组别	高血压 [例(%)]		TOAST分型[例(%)]
组别	高血压 [例(%)]		大动脉粥样硬化性		心源性脑栓塞		小动脉闭塞性		其他病因		不明原因
复发组	20(35.7)		23(41.1)		5(8.9)		24(42.9)		2(3.6)		2(3.6)
未复发组	89(30.1)		101(34.1)		26(8.8)		143(48.3)		15(5.1)		11(3.7)
统计值	χ²=7.019		χ²=1.091
P值	0.008		0.896
组别	FBG(mmol/L)		WBC(×10⁹/L)		PLT(×10⁹/L)		TC(mmol/L)		LDL-C(mmol/L)		HDL-C(mmol/L)
复发组	5.70±1.09		10.02±1.91		223.41±40.68		4.80±0.95		2.96±0.57		1.12±0.20
未复发组	5.47±1.04		9.54±1.88		215.39±37.43		4.68±0.93		2.75±0.54		1.16±0.22
统计值	t=1.506		t=1.748		t=1.450		t=0.882		t=2.645		t=1.265
P值	0.133		0.081		0.148		0.378		0.009		0.207
组别	TG(mmol/L)		UA(μmol/L)		Hcy(μmol/L)		D-D(mg/L)		NLR		PLR
复发组	1.45±0.28		302.65±58.60		15.89±2.43		0.51±0.08		3.64±0.65		133.62±20.31
未复发组	1.42±0.26		295.74±56.14		14.19±2.44		0.44±0.08		2.90±0.50		117.97±19.66
统计值	t=0.782		t=0.475		t=4.784		t=6.004		t=9.647		t=5.434
P值	0.435		0.635		<0.001		<0.001		<0.001		<0.001

指标	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
指标	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
高血压	0.920	0.313	8.639	0.002	2.509	1.359	4.634
LDL-C	0.737	0.265	7.735	0.007	2.090	1.243	3.513
Hcy	1.024	0.324	9.989	<0.001	2.784	1.475	5.254
D-D	1.248	0.351	12.642	<0.001	3.483	1.751	6.930
NLR	1.095	0.330	11.010	<0.001	2.989	1.565	5.707
PLR	0.652	0.246	7.025	0.013	1.919	1.185	3.108

指标	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
指标	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
高血压	0.920	0.313	8.639	0.002	2.509	1.359	4.634
LDL-C	0.737	0.265	7.735	0.007	2.090	1.243	3.513
Hcy	1.024	0.324	9.989	<0.001	2.784	1.475	5.254
D-D	1.248	0.351	12.642	<0.001	3.483	1.751	6.930
NLR	1.095	0.330	11.010	<0.001	2.989	1.565	5.707
PLR	0.652	0.246	7.025	0.013	1.919	1.185	3.108

预测项目	AUC	标准误	P值	95%CI		敏感度 (%)	特异度 (%)	界值
预测项目	AUC	标准误	P值	下限	上限	敏感度 (%)	特异度 (%)	界值
Hcy	0.699	0.0425	<0.0001	0.648	0.747	62.50	82.77	16.26
D-D	0.743	0.0397	<0.0001	0.694	0.788	67.86	80.41	0.50
NLR	0.770	0.0433	<0.0001	0.723	0.813	71.43	79.39	3.29
PLR	0.722	0.0404	<0.0001	0.672	0.768	66.07	81.08	133.66
联合	0.907	0.0198	<0.0001	0.872	0.935	91.07	78.72	-