实用老年医学 ›› 2025, Vol. 39 ›› Issue (9): 904-909.doi: 10.3969/j.issn.1003-9198.2025.09.009

• 临床研究 • 上一篇    下一篇

NLR、PLR和SIRI与老年缺血性脑卒中病人6个月内预后轨迹相关性的前瞻性研究

王亚男, 王姣姣, 郭道遐   

  1. 215006 江苏省苏州市,苏州大学苏州医学院护理学院
  • 收稿日期:2024-12-26 出版日期:2025-09-20 发布日期:2025-09-19
  • 通讯作者: 郭道遐,Email: dxguo@suda.edu.cn
  • 基金资助:
    国家自然科学基金资助项目(82103921)

A prospective study on the prognostic trajectories within 6 months in elderly patients with ischemic stroke in relation to NLR, PLR and SIRI

WANG Yanan, WANG Jiaojiao, GUO Daoxia   

  1. School of Nursing, Suzhou Medical College of Soochow University, Suzhou 215006, China
  • Received:2024-12-26 Online:2025-09-20 Published:2025-09-19
  • Contact: GUO Daoxia,Email:dxguo@suda.edu.cn

摘要: 目的 探究中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、系统性炎症反应指数(SIRI)与老年缺血性脑卒中病人6个月内预后轨迹的相关性。 方法 本研究纳入苏州市两家三甲医院200例缺血性脑卒中病人,分别于入院后14 d、1个月、3个月和6个月采用改良Rankin量表(mRS)评估预后。基于多时点mRS评分,采用潜在类别增长模型(LCGM)识别预后轨迹类别。将NLR、PLR、SIRI各指标按四分位数分组,采用有序logistic回归分析单个炎症指标与预后轨迹的关联性,并利用限制性立方样条分析炎症指标与预后轨迹间的剂量-反应关系。根据各指标中位数将病人分为高值组和低值组,按高炎症指标数量(0个、1个、2个、3个)构建综合炎症指标,分析其与预后轨迹的关联性。 结果 LCGM识别出的最佳卒中预后轨迹类别包括3种不同结局。多变量调整后,高水平的NLR、PLR、SIRI均显著增加病人不良预后发展趋势的风险(P<0.05)。与0个高炎症指标组相比,3个高炎症指标组显著增加病人不良预后发展趋势的风险。 结论 NLR、PLR、SIRI水平升高及高炎症指标数量增加均与老年缺血性脑卒中病人不良预后发展趋势风险增加显著相关。

关键词: 缺血性脑卒中, 中性粒细胞与淋巴细胞比值, 血小板与淋巴细胞比值, 系统性炎症反应指数, 预后轨迹, 预测价值

Abstract: Objective To explore the correlation between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory response index (SIRI), and the 6-month prognostic trajectories in elderly patients with ischemic stroke. Methods This study enrolled 200 patients with ischemic stroke from two tertiary hospitals in Suzhou, China. Prognosis was assessed using the Modified Rankin Scale (mRS) at 14 days, 1 month, 3 months, and 6 months after admission. Based on multi-timepoint mRS scores, a Latent Class Growth Model (LCGM) was employed to identify distinct prognostic trajectory classes. NLR, PLR, and SIRI were categorized into quartiles, and their associations with prognostic trajectories were analyzed using ordered logistic regression. Restricted cubic spline analysis was applied to examine the dose-response relationship between inflammatory markers and prognostic trajectories. Patients were further divided into high- and low-value groups based on median levels of each marker. A composite inflammatory index (0, 1, 2, or 3 high inflammatory markers) was constructed to evaluate its association with prognostic trajectories. Results LCGM identified a best model including three distinct stroke outcome trajectory categories. After multivariable adjustment, elevated levels of NLR, PLR, and SIRI were all significantly associated with an increased risk of unfavorable outcome progression trends (P<0.05). Compared to the group with 0 elevated inflammatory markers, the group with 3 elevated inflammatory markers showed a significantly higher risk of unfavorable outcome progression. Conclusions Elevated NLR, PLR, and SIRI levels, as well as an increased number of elevated inflammatory markers, were significantly associated with a higher risk of unfavorable outcome progression in elderly patients with ischemic stroke.

Key words: ischemic stroke, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, systemic inflammatory response index, prognostic trajectory, predictive value

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