急性脑梗死后脾脏体积的变化及其与免疫炎性反应和血小板反应性的关系  

The change of spleen volume after acute cerebral infarction and its relationship with inflammatory response and platelet reactivity

作　　者：崔兴华[1] 王晶[1] 孙超[1] 王彤[1] 沈腾群 徐新美[1] 李振光[1] 张金彪[1] Cui Xinghua;Wang Jing;Sun Chao;Wang Tong;Shen Tengqun;Xu Xinmei;Li Zhenguang;Zhang Jinbiao(Department of Neurology,Weihai Municipal Hospital,Weihai,Shandong 264200,Chin)

机构地区：[1]山东省威海市立医院神经内科,264200

出　　处：《中华神经科杂志》2018年第7期526-532,共7页Chinese Journal of Neurology

摘　　要：目的观察急性脑梗死患者发病后脾脏体积的变化，探讨脾脏体积与血小板反应性、炎性因子水平和淋巴细胞亚群数量的关系。方法收集2017年1—6月于威海市立医院神经内科住院的急性脑梗死患者30例，分别于发病24 h内、48 h以及4、7 d时检测脾脏体积、阿司匹林治疗后花生四烯酸诱导的血小板最大聚集率（AA－MAR）、干扰素－γ、淋巴细胞亚群。选取基础资料匹配的非急性脑梗死患者20例作为对照组，于入院时检测上述指标作为基线数据。比较不同时间点的脾脏体积、AA－MAR、干扰素－γ、淋巴细胞亚群的变化。采用Pearson相关分析检测血小板反应性、炎性因子水平、淋巴细胞亚群与脾脏体积的关系。结果与对照组[（120.12±10.28） cm^3]相比，急性脑梗死患者发病24 h内[（117.48±7.93） cm^3]和发病48 h[（111.61±9.21） cm^3]的脾脏体积均显著缩小（t＝－2.142, P〈0.05；t＝－2.790，P〈0.01），发病4 d[（121.31±8.16） cm^3]和7 d[（126.11±10.31） cm^3]的脾脏体积均显著增大（t＝2.242, P〈0.05；t＝2.762, P〈0.01），4个时间点的脾脏体积变化整体呈先缩小再增大的双相趋势。与对照组相比，急性脑梗死患者上述4个时间点AA－MAR水平（对照组：20.97%±8.21%；24 h内：31.86%±9.54%, t＝3.165, P〈0.01；48 h：41.38%±8.55%，t＝3.254, P〈0.01；4 d：35.34%±8.15%, t＝3.203，P〈0.01；7 d：29.38%±10.46%，t＝2.494，P〈0.05）和干扰素－γ水平（pg/L,对照组：15.21±5.21；24 h内：29.75±4.57，t＝3.262，P〈0.01；48 h：43.37±12.15，t＝3.304，P〈0.01；4 d：40.44±9.86, t＝3.291，P〈0.01；7 d：20.93±5.51, t＝2.417，P〈0.05）均显著升高，AA－MAR水平以发病48 h最高，干扰素－γ水平以发病4 d最高；与对照组相比，急性脑梗死患者4个检测时间点的T4、B和自然杀伤淋巴细胞水平均显著升高，总体均呈现逐渐升高趋势，T8淋巴细胞水平ObjectiveTo observe the changes of spleen volume in patients with acute cerebral infarction, and to explore the relationship between the spleen volume and platelet reactivity, inflammatory factors＇ lymphocyte subsets.MethodsThis is a case control study. Thirty patients with acute cerebral infarction from January 2017 to June 2017 in Department of Neurology, Weihai Municipal Hospital were included. The spleen volume, arachidonic acid-induced maximum platelet aggregation ratio （AA-MAR）, interferon gamma （IFN-γ） and lymphocyte subsets of patients were monitored in 24 hours of stroke, at 48 hours of stroke, at four days of stroke and at seven days of stroke. Twenty patients without acute cerebral infarction with the same baseline data were selected as the control group, to determine the baseline of spleen volume, AA-MAR, IFN-γ and lymphocyte subsets. A t test was used to describe the changes of spleen volume, AA-MAR, IFN-γ and lymphocyte subsets at different time points, and Pearson＇s correlation analysis was used to estimate the relationship between the spleen volume and these variables.ResultsCompared with the control group （（120.12±10.28） cm^3）, the patients with acute cerebral infarction in 24 hours of stroke （（117.48±7.93） cm^3） and at 48 hours of stroke （（111.61±9.21） cm^3） had smaller spleen volume （t=-2.142, P〈0.05; t=-2.790, P〈0.01）, whereas at four days （（121.31±8.16） cm3） and seven days of stroke （（126.11±10.31） cm^3） had bigger spleen volume （t=2.242, P〈0.05; t=2.762, P〈0.01）, with the spleen volume decreased first and increased later. Compared with the control group, the patients with acute cerebral infarction had more AA-MAR （control group： 20.97%±8.21%; 24 h： 31.86%±9.54%, t=3.165, P〈0.01; 48 h： 41.38%±8.55%, t=3.254, P〈0.01; 4 d： 35.34%±8.15%, t=3.203, P〈0.01; 7 d： 29.38%±10.46%, t=2.494, P〈0.05） and IFN-γ（pg/L, control group： 15.21±5.21; 24 h： 29.75±4.57, t=3.262, P〈0.01; 48 h： 43.37±1

关 键 词：卒中 脾 血小板聚集 干扰素Γ 淋巴细胞 

分 类 号：R743.33[医药卫生—神经病学与精神病学]