摘要
目的 探讨外周血白细胞计数(white blood cell count,WBC)与急性缺血性脑卒中(acute ischemic stroke,AIS)静脉溶栓患者早期神经功能恶化(earlyneurologicaldeterioration,END)的相关性。方法 连续纳入2019年1月—2021年12月云南省滇南中心医院卒中单元进行阿替普酶(alteplase,r-tPA)静脉溶栓的AIS患者。收集患者的临床、影像学和实验室检查资料。END定义为AIS r-tPA静脉溶栓后24 h,美国国立卫生研究院卒中量表(NIHSS)评分最高分较入院时增加≥2分。应用多变量logistic回归分析确定WBC与END的独立相关性。结果 共纳入175例AIS患者,共有28例(16.00%)患者发生END。END组与非END组在WBC、基线NIHSS评分、Org10172治疗急性卒中试验(TOAST)分型、牛津郡社区卒中计划(OSCP)分型和入院时舒张压方面差异有统计学意义(P<0.05);两组患者在人口统计学、血管危险因素、入院时收缩压、其余实验室检查结果、发病到静脉溶栓时间(ONT)等临床资料方面均差异无统计学意义(P>0.05)。单因素发现,是否发生END与WBC、基线NIHSS评分、舒张压、OSCP分型、TOAST分型有关,差异有统计学意义(P<0.05)。多变量logistic回归分析显示,以性别为分层变量基础上调整舒张压、TOAST分型、 OSCP分型后,WBC与END呈显著独立正相关(OR=1.32,95%CI:1.07~1.63,P=0.004);而男性WBC(P=0.899)与END无明显关系,总体人群呈显著独立正相关(OR=1.31,95%CI:1.08~1.89,P=0.005)。结论 WBC增高与AIS患者静脉溶栓后24h发生END呈正相关,是病情恶化及出现不良事件的危险因素,尤其是女性患者更是如此。
Objective To investigate the correlation between peripheral white blood cell count(WBC) and early neurological function deterioration(END) in patients with acute ischemic stroke(AIS) undergoing intravenous thrombosis.Methods AIS patients undergoing intravenous thrombosis in the stroke unit of Southern Central Hospital of Yunnan Province,from January 2019 to December 2021 were included.Clinical,imaging and laboratory examination data were collected.Multivariate logistic regression analysis was used to determine the independent correlation between WBC and END.END was defined as an increase of≥2 points in the maximum Score of the National Instiute of Health Stroke Scale(NIHSS) at 24 hours after intravenous thrombolysis for AIS from admission.Results A total of 175 AIS patients were included,and 28 patients(16.00%) were diagnosed END.There were significant differences in WBC,neutrophil count,NIHSS score,TOAST classification,OSCP classification,and diastolic blood pressure between the END and non-END groups.There were no significant differences in clinical data,such as demography,vascular risk factors,systolic blood pressure level at admission,other laboratory examination results,and time from onset to intravenous thrombosis between the two groups.Univariate analysis showed that the occurrence of END in the outcome variable was significantly associated with WBC,NIHSS score,diastolic blood pressure,OSCP classification and TOAST classification.Multivariate logistic regression analysis showed that after adjusting for diastolic blood pressure,TOAST classification,and OSCP classification on the basis of gender as stratified variables,WBC was positively and independently correlated with END(OR=1.32,95%CI:1.07~1.63,P=0.004).There was no significant correlation between WBC and END in males(P=0.899),but there was a significant independent positive correlation between WBC and END in the general population(OR=1.31,95%CI:1.08~1.89,P=0.005).Conclusion WBC elevation is positively correlated with the occurrence of END 24 hours aft
作者
陶万清
李瀛
王凡
刘睿
沈曼
TAO Wanqing;LI Ying;WANG Fan;LIU Rui;SHEN Man(Second Department of Neurology,Yunnan Central Hospital,Honghe 661199,Yunnan Province,China;Medical Department of Yunnan Central Hospital;Department of Respiratory and Critical Care Medicine of Yunnan Province;Quality Control Office of Yunnan Central Hospital)
出处
《中国实用乡村医生杂志》
2022年第7期53-57,61,共6页
Chinese Practical Journal of Rural Doctor
关键词
卒中
静脉溶栓
早期神经功能恶化
危险因素
Stroke
Intravenous Thrombosis
Early Neurological Function Deterioration
Risk Factor
