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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3d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 lymphocyte 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。
Purpose Inflammatory reaction is easy to appear in the pathological process of acute cerebral infarction, but the clinical significance of inflammatory response in patients with acute cerebral infarction is less. This article aims to explore the acute stage of cerebral infarction classification and counting of the severity of cerebral infarction and early clinical value of prediction. Methods The clinical data and laboratory findings of 635 patients with acute cerebral infarction (symptom onset to within 3 days after admission) were collected retrospectively from the Nanjing General Hospital of Nanjing Military Region. Neurological impairment scores at admission were scored using the National Institute of Health Stroke Score (NIHSS) and NIHSS scores on day 3 of admission. The prognosis of neurological function at discharge was assessed using the modified Rankin Scale (mRS) at discharge, with a poor prognosis at mRS> 2 points. The NIHSS admission, the NIHSS score on the 3rd day after admission and the correlation between the mRS and the leukocyte count and the leukocyte count in patients with acute cerebral infarction were analyzed. Results The number of leukocytes (OR = 1.147, 95% CI: 1.038-1.268), neutrophil count (OR = 1.227, 95% CI: 1.100-1.369), and lymphocyte count (OR = 0.508, 95% CI: 0.342-0.753) and neutrophil to lymphocyte ratio (OR = 1.150, 95% CI: 1.008-1.314). The NIHSS score at admission was correlated with the total number of leukocytes, neutrophils and lymphocytes (r = 0.078, P = 0.024; r = 0.083, P = 0.019; r = -0.010, P = 0.004) The 3-day NIHSS score correlated with the total white blood cell count, neutrophil count, lymphocyte count and NLR (r = 0.238,0.335,0.269,0.423, P <0.001). In the ROC curve, the best diagnostic value of NLR predicting a poor functional outcome (discharge mRS> 2) was 2.59 (area under the curve 0.709, specificity 70.81%, sensitivity 62.84%, P <0.001). Conclusion The classification and counting of leukocytes in acute stage of cerebral infarction have certain predictive value on the severity of neurological deficit and early poor prognosis.