摘要目的:探讨中性粒细胞百分比/白蛋白比值（neutrophil percentage-to-albumin ratio, NPAR）对老年急性缺血性卒中（acute ischemic stroke, AIS）患者静脉溶栓（intravenous thrombolysis, IVT）后转归的预测价值。方法:回顾性连续纳入2021年10月至2023年9月在阜阳市人民医院接受IVT治疗的老年AIS患者。在发病后90 d时采用改良Rankin量表评估临床转归，>2分定义为转归不良。应用多变量 logistic回归分析确定NPAR与老年AIS患者IVT后临床转归不良的相关性。应用受试者工作特征（receiver operating characteristic, ROC）曲线评估NPAR对转归不良的预测价值。 结果:共纳入148例患者，男性86例（58.1%），年龄（74.11±6.17）岁，中位基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分为5分（四分位数间距：3~8分），NPAR为1.58±0.30。转归不良组在中性粒细胞计数、中性粒细胞百分比、NPAR、空腹血糖、基线NIHSS评分方面显著高于转归良好组（ P均<0.05）。多变量 logistic回归分析显示，基线NPAR[优势比（odds ratio, OR）2.659，95%置信区间（confidence interval, CI）1.117~5.324； P<0.001]、NIHSS评分（ OR 1.191，95% CI 1.083~1.309； P<0.001）以及空腹血糖（ OR 1.224，95% CI 1.013~1.479； P=0.037）较高为患者转归不良的独立危险因素。ROC曲线分析显示，NPAR预测患者转归不良的曲线下面积为0.712（95% CI 0.613~0.812； P<0.001），最佳截断值为1.728，预测敏感性和特异性分别为65.1%和75.2%。 结论:基线NPAR较高可作为老年AIS患者IVT后转归不良的预测因素。

abstractsObjective:To investigate the predictive value of neutrophil percentage-to-albumin ratio (NPAR) on the outcome after intravenous thrombolysis (IVT) in elderly patients with acute ischemic stroke (AIS).Methods:Elderly patients with AIS who received IVT in Fuyang People's Hospital from October 2021 to September 2023 were retrospectively included. Clinical outcome were assessed by the modified Rankin Scale at 90 days after onset, with a score of >2 defined as poor outcome. Multivariate logistic regression analysis was used to determine the association between NPAR and poor clinical outcome after IVT in elderly AIS patients. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of NPAR for poor outcome. Results:A total of 148 patients were included, including 86 males (58.1%), aged (74.11±6.17) years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 5 (interquartile range: 3-8), and the NPAR was 1.58±0.30. The neutrophil count, neutrophil percentage, NPAR, fasting blood glucose and baseline NIHSS score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher baseline NPAR (odds ratio [ OR] 2.659, 95% confidence interval [ CI] 1.117-5.324; P<0.001), NIHSS score ( OR 1.191, 95% CI 1.083-1.309; P<0.001) and fasting blood glucose ( OR 1.224, 95% CI 1.013-1.479; P=0.037) were independent risk factors for poor outcome. ROC curve analysis showed that the area under the curve for NPAR to predict poor outcome was 0.712 (95% CI 0.613-0.812; P<0.001), the optimal cut-off value was 1.728, and the predictive sensitivity and specificity were 65.1% and 75.2%, respectively. Conclusion:Higher baseline NPAR may be a predictor of poor outcome after IVT in elderly AIS patients.