| Objective:The purpose of this study is to analyze the risk factors related to infarct volume in patients with massive cerebral infarction(MCI),and to evaluate the effect of NIHSS score and inflammatory index on the short-term functional prognosis of patients with acute massive cerebral infarction,so as to provide reference for early clinical precise intervention.Methods:A total of 149 patients with massive cerebral infarction admitted to The Fifth Clinical Medical College of Shanxi Medical University from May 2021 to August 2022were collected.According to the infarct volume(rCBF<30m L)assessed by RAPID software or the maximum infarct size on diffusion weighted imaging(DWI),the calculation formula was:infarct volume(cm~3)=length×width×positive layers×0.6×π/6.The patients were divided into:(1)≤70m L group,(2)71-90m L group,(3)≥91m L group.The NIHSS score,serum test index,NLR,MLR and PLR values were collected at admission,7 days after admission or at discharge.Spearman correlation analysis was used to explore the correlation between the above indexes and the volume of acute cerebral infarction.The receiver operating characteristic curve(ROC)was further drawn to evaluate its predictive efficacy for infarct volume.According to the functional improvement rate=(NIHSS at admission-NIHSS at 7days of onset or at discharge)/NIHSS at admission,the patients were divided into functional improvement:(1)≤50%group,(2)>50%group.Single factor analysis was used to screen statistically significant general clinical data and laboratory indicators at admission between the two groups,and binary logistic regression was used to analyze the influencing factors that affected the degree of functional improvement.The ROC curve was further drawn to assess the predictive efficacy of relevant indicators.Results:1.Among the 149 patients with massive cerebral infarction included in this study,38(25.51%)were in the 91 ml infarct volume group.Univariate analysis among the three groups showed that there were statistically significant differences in stroke history,atrial fibrillation history,NIHSS score,white blood cell count,neutrophil count,lymphocyte count,monocyte count,platelet count,NLR and PLR(P<0.05).2.Through ordered multiclass logistic regression analysis,it was suggested that atrial fibrillation(OR=0.219,95%CI-2.391 to-0.649,P<0.001),and stroke history(OR=0.432,95%CI-1.559 to-0.121,P<0.05)were risk factors affecting infarction volume.3.Spearman correlation analysis showed that NIHSS score(r_s=0.761,P<0.01),white blood cells(r_s=0.664,P<0.01),neutrophils(r_s=0.622,P<0.01),monocytes(r_s=0.597,P<0.01),NLR(r_s=0.731,P<0.01),PLR(r_s=0.410,P<0.01),MLR(r_s=0.701,P<0.01)were positively correlated with cerebral infarction volume.Lymphocytes(r_s=-0.512,P<0.01)were negatively correlated with infarct volume.4.Receiver operating characteristic(ROC)curve was drawn by comparing with the infarct volume(29)90m L group.The results showed that the area under the curve(AUC)of WBC was 0.886(95%CI 0.832-0.940,P<0.05).When the cut-off value was 11.145×10~9/L,the sensitivity was 84.20%and the specificity was 80.20%.The AUC of NEUT was 0.851(95%CI 0.787-0.916,P<0.05).When the optimal cutoff value was 12.475×10~9/L,the predicted sensitivity was 73.70%and the specificity was 88.30%.The AUC of LYM was 0.246(95%CI 0.169-0.324,P<0.05).When the optimal cutoff value was 0.315×10~9/L,the predicted sensitivity was 91.90%and the specificity was 8.10%.The AUC of MONO was 0.837(95%CI 0.772-0.903,P<0.05).When the optimal cutoff value was0.770×10~9/L,the predicted sensitivity was 84.20%and the specificity was 80.20%.The AUC of NLR was 0.867(95%CI 0.810-0.924,P<0.05).When the optimal cut-off value was 11.850,the predicted sensitivity was 94.70%and the specificity was 72.10%.The AUC of PLR was 0.697(95%CI 0.610-0.785,P<0.05).When the optimal cutoff value was 213.67,the predicted sensitivity was 71.10%and the specificity was 67.60%.The AUC of MLR was 0.858(95%CI 0.795-0.920,P<0.05).When the optimal cutoff value was 1.175,the predicted sensitivity was 79.50%and the specificity was 87.40%.5.The basic clinical data and serum related inflammatory test indexes of the two groups were compared,and the results showed that serum NEUT,MONO,platelet distribution width(PDW),NLR,MLR and low density lipoprotein(LDL)were increased in the NIHSS improvement rate≤50%group,while LYM was lower.The above indexes were significantly different between the two groups(P<0.05).6.The influencing factors of functional improvement(NIHSS improvement rate)at 7 days after onset were analyzed by binary logistic regression analysis,which showed that treatment,PDW,and LDL were correlated with the improvement rate of NIHSS(Table 2-8).The ROC curve was drawn:the AUC of PDW was 0.352(95%CI0.263-0.411,P<0.05).When the optimal cut-off value was 21.50f L,the sensitivity of the improvement rate≤50%was 97.40%,and the specificity was 75.70%.The AUC of LDL was 0.571(95%CI0.477-0.665,P<0.05).When the optimal cut-off value was 16.95mmol/L,the sensitivity of the improvement rate≤50%was 7.4%,and the specificity was 92.60%.7.There was a correlation between different treatment methods and short-term functional prognosis.The risk of poor neurological improvement in MCI patients with mechanical thrombectomy was 0.326 times that of the drug treatment group.Conclusion:1.In patients with large-area cerebral infarction with infarct volume≥91m L,NIHSS score,white blood cells,neutrophils,monocytes,NLR,PLR,and MLR have high predictive efficacy for assessing infarct volume.The above indicators are positively correlated with large infarct volume,while lymphocytes are negatively correlated with large infarct volume.2.PDW and LDL are indicators to predict the improvement of short-term neurological function in acute massive cerebral infarction,but the sensitivity of LDL is not significant,which needs further study.3.Compared with drug therapy,mechanical thrombectomy can achieve better prognosis in patients with large-area cerebral infarction with larger infarct volume,but it still needs to expand the sample size and dynamically collect clinical data for further evaluation. |
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