【摘要】 目的 分析急性缺血性脑卒中(AIS)患者系统免疫炎症指数(SII)、纤维蛋白原/血清清蛋白比值(FAR)与AIS患者病情严重程度的关系，并探讨二者对AIS患者接受阿替普酶(rt-PA)静脉溶栓短期预后的预测价值。方法 选取2020年5月至2021年8月于该院接受rt-PA静脉溶栓治疗的AIS患者63例为研究对象。根据美国国立卫生研究院脑卒中量表(NIHSS)评分将患者分为轻度组、中重度组；根据改良Rankin量表(mRS)评分将患者分为预后良好组与预后不良组。通过检测其血常规参数计算SII,通过分析血清生化及血浆凝血参数计算FAR;分析SII、FAR与AIS患者NIHSS评分之间的相关性；采用受试者工作特征(ROC)曲线分析SII、FAR水平对轻度、中重度AIS患者预后的预测效能。结果 中重度组FAR高于轻度组，差异有统计学意义(P<0.05)。两组SII比较，差异无统计学意义(P>0.05)。在轻度组中，SII和NIHSS评分呈正相关(r=0.460,P=0.01);FAR和NIHSS评分呈正相关(r=0.380,P=0.038)。在中重度组中，SII、FAR和NIHSS评分无相关性(r=0.051,P=0.778;r=0.007,P=0.969)。SII预测轻度AIS患者预后的准确性较低[曲线下面积(AUC)=0.688,95%CI:0.504～0.871],cut-off值为695.000;FAR预测轻度AIS患者预后有一定准确性(AUC=0.812,95%CI:0.660～0.965),cut-off值为8.600;SII预测中重度AIS患者的预后有一定准确性(AUC=0.714,95%CI:0.514～0.914),cut-off值为974.000;FAR预测中重度AIS患者的预后有一定准确性(AUC=0.750,95%CI:0.580～0.920),cut-off值为9.050。两项指标并联预测中重度AIS患者预后的灵敏度为1.000,特异度为0.444;两项指标串联预测中重度AIS患者预后的灵敏度为0.300,特异度为0.889。结论 AIS患者SII、FAR可有效评估轻度组AIS患者病情严重程度；联合SII、FAR可作为中重度AIS患者预测预后的新方法。更多还原

【Abstract】 Objective To analyze the relationships between systemic immune inflammatory index(SII), fibrinogen to serum albumin ratio(FAR) and the severity of patients with acute ischemic stroke(AIS), and to explore their predictive value for short-term prognosis of AIS patients undergoing intravenous thrombolysis with alteplase(rt-PA).Methods A total of 63 AIS patients who received intravenous thrombolytic therapy with rt-PA from May 2020 to August 2021 were selected as the research objects.According to the National Institutes of Health Stroke Scale(NIHSS) score, the patients were divided into mild group and moderate to severe group.According to the modified Rankin Scale(mRS) score, the patients were divided into good prognosis group and poor prognosis group.SII was calculated by detecting the blood routine parameters, and FAR was calculated by analyzing the serum biochemical parameters and plasma coagulation parameters.The correlations between SII,FAR and NIHSS score of AIS patients were statistically analyzed.Receiver operating characteristic(ROC) curve was used to analyze the prognostic efficacy of SII and FAR in patients with mild and moderate to severe AIS.Results FAR of moderate to severe group was higher than that of mild group, and the difference was statistically significant(P<0.05).There was no significant difference on SII between the two groups(P>0.05).There was a positive correlation between SII and NIHSS score in mild group(r=0.460,P=0.01).There was a positive correlation between FAR and NIHSS score in mild group(r=0.380,P=0.038).There was no correlation between SII,FAR and NIHSS score in moderate to severe group(r=0.051,P=0.778;r=0.007,P=0.969).The accuracy of SII in predicting the prognosis of patients with mild AIS was lower [area under curve(AUC)=0.688,95%CI: 0.504-0.871],and the cut-off value was 695.000.FAR had a certain accuracy in predicting the prognosis of patients with mild AIS(AUC=0.812,95%CI: 0.660-0.965),and the cut-off value was 8.600.SII had a certain accuracy in predicting the prognosis of patients with moderate to severe AIS(AUC=0.714, 95%CI: 0.514-0.914), and the cut-off value was 974.000.FAR had a certain accuracy in predicting the prognosis of patients with moderate to severe AIS(AUC=0.750,95%CI:0.580-0.920), and the cut-off value was 9.050.The sensitivity and specificity of the two indicators in parallel to predict the prognosis of patients with moderate to severe AIS were 1.000 and 0.444 respectively.The sensitivity and specificity of the two indexes in tandem to predict the prognosis of patients with moderate to severe AIS were 0.300 and 0.889 respectively.Conclusion SII and FAR of AIS patients could effectively evaluate the severity of AIS patients in mild group.Combined detection of SII and FAR could be used as a new prognostic method for patients with moderate to severe AIS.更多还原