白细胞分类计数对急性脑梗死患者的临床预测价值

摘要

目的：炎症反应易出现在急性脑梗死病理过程中，但炎症反应对急性脑梗死患者的临床意义的研究较少。文中旨在探讨脑梗死急性期白细胞分类计数对脑梗死严重程度及早期临床功能的预测价值。方法回顾性收集南京军区南京总医院神经内科635例急性脑梗死患者（症状开始到入院3 d以内）的临床资料及实验室检查结果。患者入院时神经功能缺损评分采用美国国立卫生院卒中量表（ National Institute of Health Stroke Score ， NIHSS）进行评分及入院第3天NIHSS评分。出院时神经功能预后情况采用出院改良Rankin量表（ modified Rankin Scale ， mRS）评分，mRS ＞2分时为预后较差。分析入院NIHSS、入院第3天NIHSS评分及出院mRS与白细胞分类计数的相关性及白细胞分类计数对急性脑梗死患者的影响。结果出院mRS（mRS＞2）的影响因素为白细胞总数（OR＝1．147，95％CI：1．038～1．268）、中性粒细胞计数（OR＝1．227，95％CI：1．100～1．369）、淋巴细胞计数（OR＝0．508，95％CI：0．342～0．753）和中性粒细胞与淋巴细胞比值（neutrophil to lym-phocyte ratio， NLR）（OR＝1．150，95％CI：1．008～1．314）。入院时NIHSS评分与早期白细胞总数、中性粒细胞计数和淋巴细胞计数相关（r＝0．078，P＝0．024；r＝0．083，P＝0．019；r＝－0．010，P＝0．004）；同时，入院第3天NIHSS评分与白细胞总数、中性粒细胞计数、淋巴细胞计数和NLR相关（r＝0．238、0．335、－0．269、0．423，P均＜0．001）。在ROC曲线中，NLR预测出院较差的功能预后（出院mRS＞2）的最佳诊断值为2．59（曲线下面积0．709，特异度为70．81％，敏感度为62．84％，P＜0．001）。结论脑梗死急性期白细胞分类计数对神经功能缺损严重程度及早期不良预后有一定的预测价值。%Objective Inflammation response is involved in the whole pathological process of acute cerebral infarction ( ACI) , but few reports are seen on its clinical implication in ACI patients .The purpose of this study was to investigate the predictive value of the differential count of leukocytes for stroke severity and early clinical outcomes in the acute phase of cerebral infarction . Methods We collected the clinical and laboratory data of 635 patients diagnosed with ACI within 72 hours of symptom onset and eval-uated the association between the differential count of peripheral blood leukocytes and stroke severity at admission and within 3 days af-ter admission as well as the clinical outcomes at discharge .The neural function impairment scores of the patients were obtained with The NIH Stroke Score ( NIHSS) at admission and on the third day after admission , and the therapeutic results evaluated with the modi-fied Rankin Scale ( mRS) , mRS >2 as poor prognosis .Analyses were performed on the correlation of the differential count of leuko-cytes with NIHSS and mRS scores and its influence on the ACI patients . Results At discharge , the mRS related influencing factors included the total count of leukocytes (OR=1.147, 95% CI:1.038-1.268), count of neutrophil cells (OR=1.227, 95% CI:1.00-1.369 ), count of lymphocytes ( OR =0.508, 95% CI:0.342-0.753), and neutrophil to lymphocyte ratio (NLR) (OR=1.150, 95%CI:1.008-1.314).the NIHSSs were correlated with the counts of leucocytes (r=0.078, P=0.024), neutrophil cells (r=0.083, P=0.019), and lymphocytes (r=0.010, P=0.004) at admission, and with the counts of leucocytes ( r =0.238, P <0.001), neutrophil cells (r=0.335, P<0.001), lymphocytes (r=-0.269, P<0.001), and NLR (r=0.423, P<0.001) on the third day after admission. Conclusion In the acute phase of cer-ebral infarction , the differential count of leukocytes and NLR are valuable for predicting the severity of neurologic impairment and early poor functional outcome .