李金慧,汪元浚

卒中后认知功能障碍（post-strokecognitiveimpairment,PSCI）是脑卒中常见的后遗症，对卒中后功能和生活质量有直接影响，给社会和家庭带来沉重的负担，对其早期诊断和预防有着重要临床意义。研究表明炎症因子与各种疾病的预后相关，本文旨在阐述中性粒细胞与淋巴细胞比值（NLR）、中性粒细胞与白蛋白比值（NAR）、单核细胞与高密度脂蛋白比值（MHR）在卒中后发生认知功能障碍的研究进展，期望为脑卒中患者早期预防认知功能障碍提供帮助。

中性粒细胞/淋巴细胞比值（NLR）；中性粒细胞/白蛋白比值（NAR）；单核细胞/高密度脂蛋白比值（MHR）缺血性脑卒中；卒中后认知功能障碍

[1] 汪凯,董强.卒中后认知障得管理专家共识2021[J].中国卒中杂志,2021,16:376-389. [2] 中国卒中学会,卒中后认知障碍管理专家委员会,徐俊.卒中后认知障碍患者门诊管理规范[J].中国卒中杂志,2019,14:909-922, [3] 《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2020》概要J].中国脑血管病杂志,2022,19:136-144. [4] Shang T, Ma B, Shen Y, et al. High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China. Front Neurol. 2022 Aug 22;13:907486. [5] Jassam YN, Izzy S, Whalen M, et al. Neuroimmunology of traumatic brain injury: time for a paradigm shift. Neuron. 2017;95:1246–1265. [6] Prinz M, Jung S, Priller J. Microglia Biology: One Century of Evolving Concepts. Cell. 2019;179(2):292-311. [7] Li Y, Liao J, Xiong L, et al. Stepwise targeted strategies for improving neurological function by inhibiting oxidative stress levels and inflammation following ischemic stroke. J Control Release. 2024;368:607-622. [8] Teng Z, Dong Y, Zhang D, et al.Cerebral small vessel disease and post-stroke cognitive impairment. Int J Neurosci. 2017;127(9):824-830. [9] Xiong XY, Liu L, Yang QW. Functions and mechanisms of microglia/macrophages in neuroinflammation and neurogenesis after stroke. Prog Neurobiol. 2016;142:23-44. [10] Dong R, Huang R, Wang J, et al. Effects of Microglial Activation and Polarization on Brain Injury After Stroke. Front Neurol. 2021;12:620948. Published 2021 Jul 1. [11] Dubbelaar ML, Kracht L, Eggen BJL,et al. The Kaleidoscope of Microglial Phenotypes. Front Immunol. 2018;9:1753. Published 2018 Jul 31. [12] Alshammari A, Han Y, Jones TW, et al. Stimulation of Angiotensin II Type 2 Receptor Modulates Pro-Inflammatory Response in Microglia and Macrophages: Therapeutic Implications for the Treatment of Stroke. Life (Basel). 2023;13(6):1274. Published 2023 May 29. [13] Hoogland IC, Houbolt C, van Westerloo DJ, et al. Systemic inflammation and microglial activation: systematic review of animal experiments. J Neuroinflammation. 2015;12:114. Published 2015 Jun 6. doi:10.1186/s12974-015-0332-6 [14] Ma C, Wang D, Li X,et al. Multivariate logistic regression analysis of clinical characteristics and risk factors of cognitive impairment after cerebral ischemic stroke: implications for clinical treatment. Ann Transl Med. 2023 Jun 30;11(9):318. [15] Tang L, Xie D, Wang S, et al. Piezo1 Knockout Improves Post-Stroke Cognitive Dysfunction by Inhibiting the Interleukin-6 (IL-6)/Glutathione Peroxidase 4 (GPX4) Pathway. J Inflamm Res. 2024;17:2257-2270. Published 2024 Apr 13. [16] 张建平,林文静,石银华,等.同型半胱氨酸、白细胞介素6与缺血性脑卒中后认知功能障碍的关系[J].中国医药导报,2023,20(05):75-78. [17] Wang L, Yang L, Liu H, et al. C-Reactive Protein Levels and Cognitive Decline following Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Brain Sci. 2023 Jul 17;13(7):1082. [18] 赵凤华,李万春,阮世旺,等.NLRP3炎症小体的活化水平与急性缺血性脑卒中患者认知功能改变的关系[J].中华行为医学与脑科学杂志,2021,30:515-521. [19] Zhu Z, Chen L, Guo D, et al. Serum Rheumatoid Factor Levels at Acute Phase of Ischemic Stroke are Associated with Poststroke Cognitive Impairment[J]. J Stroke Cerebrovasc Dis, 2019, 28: 1133-1140. [20] Xu M, Chen L, Hu Y, et al. The HALP (hemoglobin, albumin,lymphocyte, and platelet) score is associated with early-onset post-stroke cognitive impairment[J]. Neurol Sci, 2023, 44: 237-245. [21] Petrone AB, Eisenman RD, Steele KN, et al.Temporal dynamics of peripheral neutrophil and lymphocytes following acute ischemic stroke. Neurol Sci. 2019 Sep;40(9):1877-1885. [22] Jiang L, Cai X, Yao D, et al. Association of inflammatory markers with cerebral small vessel disease in community-based population[J]. J Neuroinflammation, 2022, 19: 106. [23] Gill D, Sivakumaran P, Aravind A,et al.Temporal Trends in the Levels of Peripherally Circulating Leukocyte Subtypes in the Hours after Ischemic Stroke. J Stroke Cerebrovasc Dis. 2018;27(1):198-202. [24] Hyun YM, Hong CW. Deep insight into neutrophil trafficking in various organs. J Leukoc Biol. 2017;102(3):617-629. doi:10.1189/jlb.1RU1216-521R. [25] Huang Y, Li F, Chen Z, et al. Predictive Value of Degranulating Factors of Neutrophils in Massive Cerebral Infarction. Cell Transplant. 2021;30:9636897211004089. [26] Davalos D, Akassoglou K. Fibrinogen as a key regulator of inflammation in disease. Semin Immunopathol. 2012;34(1):43-62. [27] Quaegebeur A, Lange C, Carmeliet P. The neurovascular link in health and disease: molecular mechanisms and therapeutic implications. Neuron. 2011;71(3):406-424. [28] Pluta R, Januszewski S, Czuczwar SJ. Neuroinflammation in post-ischemic neurodegeneration of the brain: friend, foe, or both? Int J Mol Sci. 2021;22(9):4405. [29] Ren H, Liu X, Wang L, et al. Lymphocyte-to-Monocyte Ratio: A Novel Predictor of the Prognosis of Acute Ischemic Stroke[J]. J Strok Cerebrovasc Dis, 2017, 26: 2595-2602. [30] Faura J, Bustamante A, Miró-Mur F, et al.Stroke-induced immunosuppression: implications for the prevention and prediction of post-stroke infections. J Neuroinflammation. 2021;18(1):127. Published 2021 Jun 6. [31] Zagrean AM, Hermann DM, Opris I,et al.Multicellular Crosstalk Between Exosomes and the Neurovascular Unit After Cerebral Ischemia. Therapeutic Implications. Front Neurosci. 2018;12:811. Published 2018 Nov 6. [32] Li J, Wang J, Wu B, et al. Association between early cognitive impairment and midterm functional outcomes among Chinese acute ischemic stroke patients: a longitudinal study. Front Neurol. 2020;11:20. [33] Li Y,An D,Xie X,et al.The relationship between neutrophil-to-lymphocyte ratio and cerebral [34] Collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion.J Clin Neurosci.2023;108:13-8. [35] Hung KC, Liu CC, Wu JY, et al.Association between the neutrophil-to-lymphocyte ratio and cognitive impairment: a meta-analysis of observational studies. Front Endocrinol (Lausanne). 2023;14:1265637. Published 2023 Nov 28. [36] Chen C,Gu L,Chen L,et al.Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential predictors of prognosis in acute ischemic stroke.Front Neuro/.2020;11:525621. [37] Jacobs T, Jacobson SR, Fortea J, et al. The neutrophil to lymphocyte ratio associates with markers of Alzheimer's disease pathology in cognitively unimpaired elderly people. Preprint. Res Sq. 2024;rs.3.rs-4076789. Published 2024 Mar 14. [38] Lee M, Lim JS, Kim CH, et al. High Neutrophil-Lymphocyte Ratio Predicts Post-stroke Cognitive Impairment in Acute Ischemic Stroke Patients. Front Neurol. 2021;12:693318. Published 2021 Jul 1. doi:10.3389/fneur.2021.693318. [39] Shang T, Ma B, Shen Y, et al. High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China. Front Neurol. 2022 Aug 22;13:907486. [40] Lin X,Ke F,Chen M.Association of albumin levels with the risk of intracranial atherosclerosis.BMC Neurol.2023;23:198. [41] Clark C,Richiardi J,Marechal B,et al.Systemic and central nervous system neuroinflammatory signatures of neuropsychiatric symptoms and related cognitive decline in older people.J Neuroinflammation.2022;19(1):127. [42] Zuo L, Dong Y, Liao X, et al. Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study. Clin Interv Aging. 2024 Jan 10;19:81-92. [43] Yuan M, Chen SJ, Li XL,et al. Blood Pressure and the Risk of Alzheimer's Disease: Is There a Link?. Am J Alzheimers Dis Other Demen. 2016;31(1):97-98. [44] 刘曼丽,钟金锋,刘雄,覃小丽.牛血清白蛋白与辛烯基琥珀酸淀粉酯糖基化产物改善谷维素的理化性质和生物可及度[J].食品与发酵工业,2022,48(24):166-171 [45] 彭菲,王瑞萍,张薇,等.银杏叶提取物注射液联合多哌奈齐治疗老年血管性痴呆的效果及对认知功能氧化应激反应的影响[J].河北医学,2022,28(09):1577-1581. [46] Lee M,Lim JS,Kim Y,et al.Association between geriatric nutritional risk index and post-stroke cognitive outcomes.Nutrients.2021;13(6):1776. [47] 孟林,刘蔚玲,孙旸园.血浆白蛋白球蛋白和C反应蛋白水平与急性缺血性脑卒中后认知功能障碍的关系[J].山西医药杂志,2021,50(9):4. [48] Liu S, Chen X. MedDiet adherence score for the association between inflammatory markers and cognitive performance in the elderly: a study of the NHANES 2011-2014. BMC Geriatr. 2022 Jun 21;22(1):511. [49] Zuo L, Dong Y, Liao X, et al. Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study. Clin Interv Aging. 2024 Jan 10;19:81-92. [50] Prinz M, Jung S, Priller J. Microglia Biology: One Century of Evolving Concepts. Cell. 2019;179(2):292-311. [51] Poznyak AV, Wu WK, Melnichenko AA, et al. Signaling Pathways and Key Genes Involved in Regulation of foam Cell Formation in Atherosclerosis. Cells. 2020;9(3):584. Published 2020 Mar 1. [52] Acikgoz N, Kurtoğlu E, Yagmur J, et al. Elevated Monocyte to High-Density Lipoprotein Cholesterol Ratio and Endothelial Dysfunction in Behçet Disease. Angiology. 2018;69(1):65-70. [53] Rogacev KS, Zawada AM, Emrich I, et al. Lower Apo A-I and lower HDL-C levels are associated with higher intermediate CD14++CD16+ monocyte counts that predict cardiovascular events in chronic kidney disease. Arterioscler Thromb Vasc Biol. 2014; 34: 2120-2127. [54] 李艳,苏志强,张彬.单核细胞/高密度脂蛋白比值与急性脑梗死出血性转化和预后的研究[J].中国临床神经科学,2021(002):029. [55] 王海英,涂宇,刘礼斌等.老年急性缺血性脑卒中患者认知功能障碍的预测模型研究[J].中华保健医学杂志,2021,23(06):608-611. [56] Xu Q, Wu Q, Chen L,et al. Monocyte to high-density lipoprotein ratio predicts clinical outcomes after acute ischemic stroke or transient ischemic attack. CNS Neurosci Ther. 2023 Jul;29(7):1953-1964. [57] Li Y, Chen D, Sun L,et al. Monocyte/High-Density Lipoprotein Ratio Predicts the Prognosis of Large Artery Atherosclerosis Ischemic Stroke. Front Neurol. 2021 Nov 29;12:769217. [58] 徐赏.MHR,NLR与急性缺血性脑卒中病情严重程度和近期预后的相关性研究[J].[2023-07-24].

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