由佳玉， 李兴强， 王正则， 高连波

血小板与淋巴细胞比值和急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系

由佳玉， 李兴强， 王正则， 高连波

目的探讨血小板与淋巴细胞比值(platelet to lymphocyte ratio，PLR)和急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系。方法根据颈动脉彩色多普勒超声仪检查结果，将184例急性脑梗死患者分为稳定斑块组64例，不稳定斑块组120例，及70例正常对照组。收集一般临床资料及缺血性脑血管病危险因素，测定白细胞计数、红细胞计数、中性粒细胞数、血脂、肌酐、尿酸等并进行比较。结果(1)与对照组相比，急性脑梗死组PLT、TC、TG、LDL-C、尿酸、纤维蛋白原、PLR、空腹血糖明显增高，差异具有统计学意义(P<0.05)；(2)不稳定斑块组与对照组相比PLR水平明显升高，具有显著性差异(P<0.05)。不稳定组PLR明显高于稳定斑块组，具有显著统计学差异(P<0.05)。(3)调整性别、年龄因素后，PLR为颈动脉不稳定斑块的危险因素(OR=1.505，95%CI0.995～1.003，P=0.001<0.05)。结论PLR的增高和颈动脉粥样硬化斑块的不稳定性密切相关。

血小板； 淋巴细胞； 脑梗死； 颈动脉粥样硬化斑块

Abstract：ObjectiveTo investigate the relationship between the stability of carotid artherosclerosis plaque and the levels of platelet to lymphocyte ratio width in patients with acute cerebral infarction.MethodsAccording to the results carotid artery color Doppler ultrasound examination，184 patients with acute cerebral infarction were divided into stable plaque group 64 patients，unstable plaque group 120 patients，and 70 cases of normal group. The collection of the general clinical data and ischemic cerebrovascular disease risk factors，white blood cell count，red blood cell count，neutrophile count，serum lipids，creatinine，uric acid，were performed and data were compared between groups.Results(1)compared with the control group，cerebral infarction group，PLT，TC，TG，LDL-C，uric acid，PLR，fibrinogen increased obviously，the difference was statistically significant(P<0.05). (2)stable plaques group，unstable plaque group compared with the control group，PLR increased significantly，with significant difference(P<0.05). The unstable plaque group was significantly higher than that of PLR level in stable plaque group，the difference was significant(P<0.05). (3)adjusted for sex，age，PLR level were the risk factors of carotid unstable plaque(OR=1.505，95%CI：0.995～1.003，P=0.001<0.05).ConclusionThe increase of PLR is closely related with carotid atherosclerosis plaque unstabillity in patients with acute cerebral infarction.

Keywords： Platelet； Lymphocyte； Cerebral infarction； Carotid atherosclerosis plaque

随着我国人口老龄化的提高，脑梗死发病率正逐年提高且呈年轻化趋势。急性脑梗死是我国中老年人致残和致死的主要原因之一。研究发现，绝大多数病例发生急性脑梗死的根本原因是动脉粥样硬化斑块基础上的血栓形成。颈动脉粥样硬化斑块是引起急性缺血性脑卒中的重要危险因素，它与脑梗死的发生、发展、复发以及梗死的部位密切相关[1]。颅外颈动脉的管腔狭窄或闭塞、动脉内膜溃疡形成、斑块内出血等病理改变，均可使脑梗死的发病率增加[2]。斑块破裂的位置一般是在纤维帽的薄弱区和不完整部分，该位置免疫细胞非常丰富，其产生大量的炎症分子及蛋白水解酶，进而导致稳定斑块向易损斑块进展。……