Association between systemic immune-inflammatory markers and the risk of moyamoya disease: a case-control study

<b>Background:</b> Systemic immune-inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammatory index (SII) are associated with the prognosis of many cardiovascular and neoplastic diseases. Moyamoya disease (MMD) is associated with inflammation, but the relationship between systemic immune-inflammatory markers between MMD is unclear. The aim of our study was to analyse the association between systemic immune-inflammatory markers and the risk of MMD and its subtypes. <b>Methods:</b> We consecutively recruited 360 patients with MMD and 89 healthy control subjects in a case-control study to calculate and analyse the association of systemic immune-inflammatory markers with the risk of MMD and its subtypes. <b>Results:</b> The risk of MMD increased with higher levels of NLR (OR 1.237, 95% CI [1.008, 1.520], <i>p</i> = .042). When NLR and SII were assessed as quartile-spaced subgroups, the third quartile grouping of NLR and SII had a higher risk of MMD than the first quartile grouping (NLR: OR 3.206, 95% CI [1.271, 8.088], <i>p</i> = .014; SII: OR 3.074,95% CI [1.232,7.672], <i>p</i> = .016). When NLR was combined with SII, the highest subgroup had a higher risk of MMD than the lowest subgroup (OR2.643, 95% CI [1.340, 5.212], <i>p</i> = .005). The risk of subtypes also increased with higher levels of NLR and SII. The association between the levels of NLR and SII with the staging of the Suzuki stage follows an inverted U-shape. The highest levels of NLR and SII were found in patients with MMD at Suzuki stages 3–4. <b>Conclusion:</b> The risk of MMD increases with elevated systemic immune-inflammatory markers. This study analysed the association of systemic immune-inflammatory markers with the risk of developing MMD and its subtypes, and identified novel inflammatory markers for MMD. Systemic immune-inflammatory markers such as neutrophil–lymphocyte ratio and systemic immune-inflammatory index were higher in moyamoya disease (MMD) patients than in normal people.Systemic immune-inflammatory markers may be an independent risk factor for the onset of MMD.Systemic immune-inflammatory markers were associated with the progression of MMD, and their levels showed an inverted U shape with imaging stages. Systemic immune-inflammatory markers such as neutrophil–lymphocyte ratio and systemic immune-inflammatory index were higher in moyamoya disease (MMD) patients than in normal people. Systemic immune-inflammatory markers may be an independent risk factor for the onset of MMD. Systemic immune-inflammatory markers were associated with the progression of MMD, and their levels showed an inverted U shape with imaging stages.

<b>背景：</b> 系统性免疫炎症标志物，如中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）、血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）、淋巴细胞与单核细胞比值（lymphocyte-to-monocyte ratio, LMR）以及系统性免疫炎症指数（systemic immune-inflammatory index, SII），均与多种心血管疾病及肿瘤性疾病的预后密切相关。烟雾病（moyamoya disease, MMD）与炎症反应存在关联，但目前系统性免疫炎症标志物与MMD之间的关联尚不明确。本研究旨在分析系统性免疫炎症标志物与MMD及其亚型的发病风险之间的关联。<b>方法：</b> 本研究采用病例对照研究设计，连续纳入360例MMD患者及89例健康对照者，通过分析计算明确系统性免疫炎症标志物与MMD及其亚型发病风险的关联。<b>结果：</b> MMD的发病风险随NLR水平升高而升高（优势比OR=1.237，95%置信区间CI=[1.008, 1.520]，P=0.042）。将NLR与SII按四分位数分层分析时，NLR及SII的第三四分位数组的MMD发病风险均高于第一四分位数组（NLR：OR=3.206，95%CI=[1.271, 8.088]，P=0.014；SII：OR=3.074，95%CI=[1.232, 7.672]，P=0.016）。当联合分析NLR与SII时，最高水平亚组的MMD发病风险显著高于最低水平亚组（OR=2.643，95%CI=[1.340, 5.212]，P=0.005）。MMD亚型的发病风险同样随NLR与SII水平升高而升高。NLR及SII水平与铃木分期（Suzuki stage）呈倒U型关联，Suzuki分期3~4期的MMD患者的NLR及SII水平最高。<b>结论：</b> MMD的发病风险随系统性免疫炎症标志物水平升高而升高。本研究明确了系统性免疫炎症标志物与MMD及其亚型发病风险的关联，并为MMD筛选出了新型炎症标志物。烟雾病（MMD）患者的中性粒细胞-淋巴细胞比值及系统性免疫炎症指数等系统性免疫炎症标志物水平均高于健康人群。系统性免疫炎症标志物或可作为MMD发病的独立危险因素。系统性免疫炎症标志物与MMD的疾病进展相关，其水平随影像学分期呈现倒U型分布。烟雾病（MMD）患者的中性粒细胞-淋巴细胞比值及系统性免疫炎症指数等系统性免疫炎症标志物水平均高于健康人群。系统性免疫炎症标志物或可作为MMD发病的独立危险因素。系统性免疫炎症标志物与MMD的疾病进展相关，其水平随影像学分期呈现倒U型分布。