Potential of a combination of peripheral Hcy, D-D, NLR and PLR in predicting the recurrence of acute cerebral infarction after a thrombolytic therapy

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

Abstract

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

CLC Number:

R743.33

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

Figures/Tables 4

References 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	-