知识与财富的链接
目的 探讨多种炎症标志物对孤立性延髓内侧梗死（medial medullary infarction, MMI）患者早期神经功能恶化（early neurological deterioration, END）的预测价值。 方法 回顾性连续纳入2020年1月至2025年2月天津医科大学总医院神经内科收治的MMI患者。收集并比较END组与非END组人口统计学和临床资料。采用多变量 logistic回归分析确定END的独立预测因素,受试者工作特征（receiver operating characteristic, ROC）曲线评估预测因素对END的预测效能。 结果 共纳入87例MMI患者,男性55例（63.22%）,年龄（62.47±11.99）岁,中位基线美国国立卫生研究院卒中量表评分5分（四分位数间距：3~6分）;26例（29.89%）发生END。END组白细胞计数、中性粒细胞计数、中性粒细胞/高密度脂蛋白胆固醇比值（neutrophil-to-high-density lipoprotein cholesterol ratio, NHR）、全身免疫炎症指数（systemic immune-inflammation index, SII）等炎症指标显著高于非END组（经Bonferroni校正, P均<0.002 9）。多变量 logistic回归分析显示,NHR[优势比（odds ratio, OR）1.795,95%置信区间（confidence interval, CI）1.114~2.891; P=0.016]和SII（ OR 1.002,95% CI 1.000~1.004; P=0.013）是MMI患者发生END的独立危险因素。ROC曲线分析表明,NHR（曲线下面积=0.873,95% CI 0.785~0.935）和SII（曲线下面积=0.881,95% CI 0.803~0.959）对END均具有良好的预测价值。 结论 NHR和SII是MMI患者发生END的可靠预测指标,有助于早期识别高危患者并实施个体化干预。
Objective To investigate the predictive value of multiple inflammatory markers for early neurological deterioration (END) in patients with isolated medial medullary infarction (MMI). Methods Consecutive patients with MMI admitted to the Department of Neurology, Tianjin Medical University General Hospital from January 2020 to February 2025 were included retrospectively. The demographic and clinical data were collected and compared between the END group and the non-END group. Multivariate logistic regression analysis was used to identify the independent predictive factors for END, and the receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of these factors for END. Results A total of 87 patients with MMI were enrolled, including 55 males (63.22%), aged 62.47±11.99 years, with a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 5 (interquartile range, 3-6); 26 patients (29.89%) experienced END. The inflammatory indicators such as leukocyte count, neutrophil count, neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), and systemic immune-inflammation index (SII) in the END group were significantly higher than those in the non-END group (all P<0.002 9 after Bonferroni correction). Multivariate logistic regression analysis showed that NHR (odds ratio [ OR] 1.795, 95% confidence interval [ CI] 1.114-2.891; P=0.016) and SII ( OR 1.002, 95% CI 1.000-1.004; P=0.013) were the independent risk factors for END in patients with MMI. ROC curve analysis showed that both of NHR (area under the curve [AUC]=0.873, 95% CI 0.785-0.935) and SII (AUC=0.881, 95% CI 0.803-0.959) had good predictive value for END. Conclusion NHR and SII are the reliable predictive indicators for END in patients with MMI, which help to identify high-risk patients early and implement personalized interventions.
