Evaluation value of transesophageal echocardiography combined with PLR and NLR in patients with patent foramen ovale complicated with cryptogenic stroke
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摘要:
目的 探讨经食道心脏超声(TEE)联合血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)在卵圆孔未闭(PFO)患者合并隐源性卒中的评估应用。 方法 选取本院2019年8月~2021年8月收治的卵圆孔未闭患者132例，其中合并隐源性卒中23例。所有患者均接受TEE检测，测量PFO直径，并行血常规检测，根据血小板、淋巴细胞、中性粒细胞计数计算PLR、NLR比值，比较PFO合并隐源性卒中和未合并隐源性卒中PLR、NLR比值的差异性，采用Spearman法分析PFO直径、PLR、NLR与PFO合并隐源性卒中的相关性，采用ROC曲线分析PFO直径和PLR、NLR检测在卵圆孔未闭合并隐源性卒中的评估价值。 结果 TEE检测发现PFO未合并隐元性卒中患者PFO直径低于合并隐源性卒中(P < 0.05)，造影可见房水平不同级别的右向左分流；PFO患者合并隐源性卒中PLR、NLR比值高于未合并隐源性卒中患者(P < 0.05)；Spearman分析显示：PFO直径及PLR、NLR比值与PFO合并隐源性卒中风险呈正相关关系(r=0.385、0.429、0.378，P < 0.05)；ROC曲线显示：PFO直径联合PLR、NLR评估PFO合并隐源性卒中风险曲线下面积高于PLR、NLR单项指标曲线下面积(P < 0.05)。 结论 TEE可以较好地分辨PFO直径，结合PLR、NLR检测有助于评估PFO合并隐源性卒中的发生风险。 -
关键词:
- 卵圆孔未闭 /
- 隐源性卒中 /
- 心源性血栓 /
- 经食道心脏超声检测 /
- 血小板/淋巴细胞比值 /
- 中性粒细胞/淋巴细胞比值
Abstract:Objective To investigate the the application of transesophageal echocardiography (TEE) combined with platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) in the evaluation of cryptogenic stroke in patients with patent foramen ovale (PFO). Methods Thirty-two patients with patent foramen ovale admitted in our hospital from August 2019 to August 2021 were selected, including 23 patients with cryptogenic stroke. All patients received TEE detection, PFO diameter was measured, and blood routine tests were performed. PLR and NLR ratios were calculated according to the counts of platelets, lymphocytes, and neutrophils. The differences of PLR and NLR ratios between PFO with cryptogenic stroke and non cryptogenic stroke were compared. Spearman was used to analyze the correlation between PFO diameter, PLR, NLR and PFO with cryptogenic stroke. The evaluation value of PFO diameter, PLR and NLR detection in patent foramen ovale combined with cryptogenic stroke was analyzed by receiver operating characteristic curve. Results TEE test showed that the diameter of PFO in patients with PFO without cryptogenic stroke was significantly lower than that with cryptogenic stroke (P < 0.05), and angiography showed different levels of right-to-left shunts at the atrial level. PFO patients with cryptogenic stroke PLR, NLR ratio was significantly higher than that in patients without cryptogenic stroke (P < 0.05). Spearman analysis showed that PFO diameter, PLR, NLR ratio were positively correlated with the risk of PFO combined with cryptogenic stroke (r=0.385, 0.429, 0.378, P < 0.05). PFO The area under the curve of diameter combined with PLR and NLR to assess the risk of PFO combined with cryptogenic stroke was significantly higher than the area under the curve of PLR and NLR single index (P < 0.05). Conclusion TEE can better distinguish the diameter of PFO, and the combination of PLR and NLR can help to evaluate the risk of PFO complicated with cryptogenic stroke. -
图 1 右心声学造影图像
A: Ⅰ级; B: Ⅱ级; C: Ⅲ级.
Figure 1. Right cardiac acoustic contrastographic picture.
图 2 TEE联合PLR、NLR评估PFO合并隐源性卒中的风险价值
Figure 2. TEE in combination and PLR and NLR to assess the risk value of PFO combined with cryptogenic stroke.
表 1 PLR、NLR比较
Table 1. Comparison of PLR and NLR(Mean±SD)
组别 PLR NLR 合并隐源性卒中(n=23) 149.88±28.07 2.92±1.07 未合并隐源性卒中(n=109) 116.31±28.48 1.85±0.52 t 5.149 4.710 P < 0.001 < 0.001 PLR: 血小板/淋巴细胞比值; NLR: 中性粒细胞/淋巴细胞比值. 
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表 2 TEE联合PLR、NLR评估PFO合并隐源性卒中的风险价值
Table 2. TEE combined with PLR and NLR to assess the risk value of PFO combined with cryptogenic stroke
指标 AUC 截断值 敏感度 特异性 95% CI 约登指数 PFO直径 0.826 2.98 mm 0.652 0.917 0.723~0.929 0.569 PLR 0.788* 135.47 0.696 0.761 0.685~0.891 0.457 NLR 0.793* 2.73 0.609 0.945 0.675~0.911 0.554 联合 0.908 - 0.739 0.973 0.836~0.980 0.712 PFO: 卵圆孔未闭; *P < 0.05 vs联合.
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