溶栓后中性粒细胞升高与缺血性脑卒中早期神经功能恶化相关性研究  

The relationship between neutrophil elevation and early neurological deterioration after thrombolysis in patients with ischemic stroke

作　　者：钱新宇 杨思远 Bilal Muhammad 杜波 耿德勤 QIAN Xinyu;YANG Siyuan;DU Bo;GEN Deqin(Department of Neurology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004,P.R.China;Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221002,P.R.China)

机构地区：[1]徐州医科大学附属医院神经内科,江苏徐州221004 [2]徐州医科大学研究生学院,江苏徐州221002

出　　处：《华西医学》2019年第6期641-648,共8页West China Medical Journal

基　　金：徐州市医学创新(技术攻关)团队培养项目(XWCX201602)

摘　　要：目的探讨溶栓后中性粒细胞升高与缺血性脑卒中早期神经功能恶化(early neurological deterioration,END)发生的相关性。方法收集2017年1月-2018年11月的发病4.5 h内接受阿替普酶静脉溶栓治疗患者的临床资料。根据是否出现END,分为END组和非END组,观察两组患者溶栓前后中性粒细胞、淋巴细胞等指标的变化,以探讨基线及溶栓后中性粒细胞、淋巴细胞和中性粒细胞/淋巴细胞比率与END的相关性。结果共纳入患者187例,其中END组48例,非END组139例。溶栓前,两组患者除总蛋白(t=2.130,P=0.035)、白蛋白(t=2.777,P=0.007)外,其余指标比较差异均无统计学意义(P>0.05)。溶栓后,白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值、纤维蛋白酶降解产物、基线和变化美国国立卫生研究院卒中量表评分、心源性脑卒中、责任血管狭窄程度及前循环皮质梗死部位,END组均高于非END组(P<0.05);而总蛋白、白蛋白、淋巴细胞计数、前白蛋白END组低于非END组(P<0.05)。溶栓前后,END组中性粒细胞增加明显(Z=-2.314,P=0.021)。中性粒细胞计数[比值比=1.288,95%置信区间(1.069,1.552)]为静脉溶栓END的独立影响因素之一;且预测END的特异度最高(灵敏度为62.5%,特异度为71.9%)。结论溶栓后中性粒细胞升高与END的发生有一定相关性。动态监测静脉溶栓治疗后的中性粒细胞可有助于预测END的发生。Objective To explore the relevance of an increase in neutrophil count and early neurological deterioration(END) after intravenous thrombolysis in patients with acute ischemic stroke. Methods A retrospective study was conducted on the patients who received thrombolysis treatment of alteplase within 4.5 hours after onset between January 2017 and November 2018. Based on the existence of END, the patients were divided into the END group and the non-END group. Univariate and multivariate logistic regression, and receiver operating characteristic curves were used to analyze the relevances between END and the indexes such as neutrophil count, lymphocyte count, and neutrophil to lymphocyte ratio(NLR) after thrombolysis. Paired sample t test and Wilcoxon signed-rank test were used to compare the changes of neutrophil and lymphocyte before and after thrombolysis. Results A total of 187 patients were included,including 48 in the END group and 139 in the non-END group. Before thrombolysis, the differences of total protein(t=2.130, P=0.035) and albumin(t=2.777, P=0.007) between the two groups were statistically significant, but the differences in other clinical indexes between the two groups were not statistically significant(P>0.05). After thrombolysis,white blood cell count, neutrophil count, NLR, fibrinase degradation product, baseline and change of National Institute of Health Stroke Scale score, proportion of cardiogenic embolism, degree of responsible vascular stenosis and anterior circulation cortical infarction site were all higher in the END group than those in the non-END group(P<0.05). The total protein, albumin, lymphocyte count and prealbumin in the END group were lower than those in the non-END group(P<0.05). Neutrophil in the END group increased significantly(Z=-2.314, P=0.021) after thrombolysis. Neutrophil count[odds ratio=1.288, 95% confidence interval(1.069, 1.552)] was one of the independent influencing factors of venous thrombolysis END, and the specificity was the highest(the sensitivity was 62.5%, and t

关 键 词：急性缺血性脑卒中 静脉溶栓 早期神经功能恶化 中性粒细胞计数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]