The Correlation Between Peripheral Blood Cell Inflammatory Markers And Acute Ischemic Stroke

Background:Acute ischemic stroke accounted for about 80%of all types of cerebral stroke with high incidence,high mortality,high disability rate and high economic burden.It seriously affected the quality of life of these patients and caused great burden to the family and society.More and more studies have shown that inflammatory response plays an important role in the development of acute ischemic stroke.Once acute ischemic stroke happens,impaired brain tissue rapidly release cytokines,chemokines and oxygen free radicals,this process can not only activate glial cells,but induce the expression of endothelial cells and peripheral white blood cell adhesion molecules,promoting the infiltration of peripheral white blood cells of ischemic brain tissue,the white blood cells and microglia further release cytokines and oxygen free radicals,leading to cell necrosis and apoptosis in ischemic brain tissue,and aggravate the damage of blood-brain barrier,affecting the prognosis of patients with acute ischemic stroke.In recent years,peripheral blood neutrophil to lymphocyte ratio(NLR),derived neutrophil to lymphocyte ratio(dNLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR)were found to be important peripheral blood cells biomarkers to predict the prognosis of acute myocardial infarction,heart failure and cancer.At present,there are few studies reporting the relationship between these new biomarkers and the prognosis of patients with acute ischemic stroke at home and abroad.This study intends to discuss the correlation between the baseline NLR,dNLR,PLR and LMR of patients with acute ischemic stroke and the severity of the disease,also to evaluate their predictive value of short-term prognosis,in order to provide appropriate and convenient basis for clinicians to evaluate the severity of patients with acute ischemic stroke and predict their short-term prognosis.Purpose:To find out the appropriate inflammatory markers for predicting the severity and short-term prognosis of patients with acute ischemic stroke and provide suitable and simple bases for predicting the severity and short-term prognosis of patients with acute ischemic stroke.Methods:The case group came from Zhongda hospital affiliated Southeast university with a total of 210,in Nanjing Jiangsu province between December 2015 and February 2017.They were acute ischemic stroke patients for the first time proved by neurologists and CT or MRI.The time of onset to treatment was within 7 days.The patients with recurrent cerebral infarction or other neurological diseases were excluded.If the patients accepted thrombolysis therapy,had unstable vital signs or severe consciousness disorders,complicated with multiple organ dysfunction,anyone of them would be excluded.The control group were healthy people who admitted for medical examination with a total of 50 patients during the same period.We collected their demographic data and the first blood routine index,then calculated NLR(neutrophil to lymphocyte ratio).PLR(platelet and lymphocyte ratio).LMR(lymphocyte and monocyte ratio)and dNLR(indirect neutrophil to lymphocyte ratio).We analyzed the correlation between the baseline NIHSS score and NLR?PLR?LMR?dNLR.According to the 3-month mRS score after acute ischemic stroke,the case group were divided into two groups.The patient whose modified Rankin Scale score>3 was considered as poor outcome,named poor outcome group.The patient whose modified Rankin Scale score<3 was considered as good outcome,named good outcome group.ROC curve was used to evaluate the predictive value of NLR?PLR?LMR and dNLR for predicting the short-term prognosis of acute ischemic stroke patients.Results:1?The case group and the control group had no significant difference in age,gender and history(hypertension,diabetes,coronary heart disease,atrial fibrillation,alcohol,smoking)(P>0.05),but had significant difference in baseline laboratory indexes(NLR,PLR,LMR,dNLR)(P<0.05).2?A1 group(mRS score 0-2)and A2 group(mRS score 3-5)had significant difference in age,history of atrial fibrillation,baseline NLR and dNLR values(P<0.05).3?The male group and the female group had significant difference in dNLR at baseline(P>0.05)but no statistical significance in NLR,PLR and LMR at baseline(P<0.05).4?B1 group(<65 years)and B2 group(? 65 years)had no statistical significance in baseline peripheral blood cell inflammatory markers(NLR,PLR,LMR,dNLR)(p>0.05).5?The Spearman's rank correlation coefficient between baseline NIHSS score and baseline laboratory indexes(NLR,dNLR,PLR,LMR)respectively were 0.984,0.965,0.686,-0.717(P<0.05).6?ROC curve was adopted to evaluate the predictive value of NLR,PLR,LMR and dNLR for the prognosis of acute ischemic stroke patients.The results showed that the area under the NLR curve was 0.658,the optimal cutoff value was 2.5(sensitivity 80.8%,specificity 47%).The area under the dNLR curve was 0.666,the optimal cutoff value was 1.96(sensitivity 76%,specificity 51.9%).The area under the PLR curve was 0.550,the optimal cutoff value was 108.92(the sensitivity 72%,specificity 38.4%).The area under the LMR curve was 0.646,cut-off value was 2.5(sensitivity 64%,specificity 70.3%).Conclusion:1?NLR,dNLR and LMR at baseline have a high reference value for estimating the severity of acute ischemic stroke patients.2?NLR,dNLR,LMR and PLR at baseline have a high predictive value in predicting short-term prognosis of patients with acute ischemic stroke.Among them,dNLR has the highest predictive value.