| Background and objective:Acute ischemic stroke(AIS)is the most common type of stroke in cerebrovascular diseases,accounting for about 80%of all strokes.It has a high incidence,disability and mortality,and currently ranks first among fatal diseases in China.Although antithrombotic reperfusion therapy has been improved,there are still some patients with AIS whose prognosis is not satisfactory.In view of the heavy burden of disability after stroke,more and more attention is focused on the identification of new prognostic markers.Studies have shown that inflammation plays an important role in the occurrence,development and prognosis of AIS.At present,monocyte to high-density lipoprotein cholesterol ratio(MHR)has become a new inflammatory marker and is reported to be closely related to cardiovascular events.We aim to explore the correlation between MHR and short-term poor prognosis in patients with AIS and evaluate its predictive value,so as to provide more reference for clinicians.Methods:1.Research about relationship between monocyte to high density lipoprotein ratio and short-term prognosis of patients with acute ischemic stroke:prospective and continuous collection of patients with AIS within 24 hours diagnosed and treated in the first affiliated Hospital of Zhengzhou University from January 2015 to December 2017.The prognosis of the patients was assessed according to the modified Rankin scale score(mRS),and the poor prognosis was defined as mRS score>2.According to the level of MHR on admission,the patients were divided into high and low groups,and the basic characteristics of the two groups were compared.Multivariate Logistic regression was used to evaluate the relationship between MHR level and AIS and the clinical outcome of patients with ultra-early thrombolysis.The AIS was classified according to TOAST classification to explore the effect of MHR level on the clinical outcome of.patients with different stroke subtypes.2.The value of monocyte to high density lipoprotein ratio in predicting the prognosis of patients with acute ischemic stroke:draw the Receiver Operating Characteristic(ROC)curve of subjects' working characteristics of MHR,monocyte(MONO),high-density lipoprotein cholesterol(HDL-C),Acute Stroke Registry and Analysis of Lausanne(ASTRAL)scores and calculate the sensitivity,specificity,positive predictive value and negative predictive value,Youden index of different ASTRAL scores to determine the best cut-off point.The Delong method in Medcalc 15.2 software is used to compare the area under different model curves Area Under Curve(AUC),calculate Z value and P value,explore the prediction ability of different models,evaluate the model differentiation and determine the best forecasting combination model according to C statistics.The calibration of the model was evaluated by Hosmer-Lemeshow fit test.Results:1.Research about relationship between monocyte to high density lipoprotein ratio and short-term prognosis of patients with acute ischemic stroke.(1)A total of 1090 AIS patients were enrolled in the group,of which 925(84.9%)had a good prognosis and 165(15.1%)had a poor prognosis.(2)The basic clinical data of the two groups showed that in the poor prognosis group,the level of MHR[0.53(0.37-0.69)VS 0.48(0.33-0.60),P=0.007]was significantly higher.(3)After correcting other related risk factors,multivariate logistic analysis showed that,MHR(OR 2.58,95%CI,1.21-5.51,P=0.015)was an independent risk factor for poor prognosis in patients with AIS.Subgroup analysis showed that high MHR(OR 2.39,95%CI 1.10-5.25,P=0.028)was closely related to the short-term poor prognosis of patients with AIS intravenous thrombolysis,and the subgroup analysis showed that the poor prognosis of patients with AIS intravenous thrombolysis was closely related to the poor prognosis of patients with intravenous thrombolysis.(4)Compared with the low level MHR group,the proportion of large artery atherosclerosis(LAA)stroke in patients with high level MHR was significantly higher(52.7%VS 47.7%,P=0.029),but there was no significant difference in other types of stroke.Multivariate Logistic analysis showed that among patients with LAA type,the risk of poor clinical prognosis of high-level MHR patients(OR 2.52,95%CI,1.03-6.19,P=0.034)was significantly lower than that of low-level patients.2.The value of monocyte to high density lipoprotein ratio in predicting the prognosis of patients with acute ischemic stroke;(1)Comparing the ability of MHR,MONO and HDL-C to predict the clinical outcome of AIS patients,the best predictive variable is MHR[AUC 0.67;95%CI(0.64-0.69)],and AUC is higher than MONO[AUC 0.61;95%CI(0.59-0.64);P=0.021]and HDL-C[AUC 0.56;95%CI(0.53-0.60);P<0.001].The best prediction cut-off value is 0.51,the sensitivity is 62.3%,and the specificity is 66.5%.There was no statistical difference in the predicted value between the latter two.The results of Hosmer-Lemeshow fit test showed that MHR had a good fit for the risk of 90-day poor prognosis.(2)The sensitivity and specificity of the risk model of ASTRAL score were evaluated by ROC curve.The AUC of the risk model was 0.807(0.782-0.830,P<0.001),the best cut-off value was 18,and the sensitivity and specificity were 84.24%and 60.43%,respectively.(3)Compared with MHR ? 0.51+ASTRAL ? 18,the clinical prognosis of 1090 AIS patients with MHR>0.51+ASTRAL>18 was worse than that of MHR?0.51+ASTRAL ? 18.The predicted value[AUC 0.683;95%CI(0.654-0.711),P<0.001]was significantly higher.Compared with any single variable MHR or ASTRAL score,the comb:ined predictive value[AUC 0.83;95%CI(0.81-0.85),P<0.001)]was also the highest.The test of Hosmer-Lemeshow shows that the model has a good calibration.Conclusions:1.High level of MHR on admission may be an independent risk factor for poor short-term prognosis in patients with AIS.2.The level of MHR on admission has a certain predictive value for the short-term prognosis of patients with AIS,and the predictive value of combined ASTRAL score is higher. |
PDF Full Text Request