不同侧大脑中动脉脑梗死急性期白细胞及分类变化趋势的比较研究

Comparative study on the change trend of leucocyte in patients with cerebral infarction in different sides of middle cerebral artery at acute phase

目的探讨不同侧大脑中动脉脑梗死患者急性期白细胞及分类变化趋势。方法选取收治的大脑中动脉急性脑梗死患者105例,按照梗死部位的不同分为左侧组54例和右侧组51例。观察2组患者入院后1周内外周血中白细胞计数及中性粒细胞比例、淋巴细胞比例,肺部感染发生情况,1个月时进行神经功能缺损评分(NIHSS)和残障程度评分(mRS)。结果 2组患者白细胞计数及中性粒细胞比例、淋巴细胞比例、肺部感染率,NIHSS评分和mRS评分比较差异无统计学意义(P>0.05);按有无肺部感染分层后,2组中肺部感染患者的白细胞计数及中性粒细胞比例比较差异无统计学意义(P>0.05);左侧组中无肺部感染患者发病第1天的白细胞及其分类与右侧组比较差异有统计学意义(P<0.05);2组中性粒细胞比例和淋巴细胞比例变化趋势不同,左侧组中无肺部感染患者的中性粒细胞比例在发病后第1天即升到最高,在1周内逐渐下降到正常水平,而右侧组在发病第3天出现一过性升高;左侧组无肺部感染患者的淋巴细胞比例在发病第1天即降到最低,1周内呈逐渐增高到正常水平,而右侧组在发病第3天出现一过性降低(P<0.05)。结论未发生肺部感染的不同侧大脑中动脉急性脑梗死患者的白细胞变化趋势不同,提示不同侧大脑中动脉急性脑梗死引起的免疫抑制的机制可能有所不同。

Objective To explore the change trend of leucocyte in patients with cerebral infarction in different sides of middle cerebral artery at acute phase. Methods One hundred and five patients with acute middle cerebral artery infarction who were admitted and treated in our hospital from May 2013 to May 2014 were divided into left side group（ n = 54） and right side group（ n = 51）,according to different infarction position. The white blood cell count,neutrophils proportion,lymphocytes proportion in peripheral blood,incidence of pulmonary infection within 1 week after admission were detected and compared between two groups. Moreover the neurologic functional impairment scoring（ NIHSS） and degree of disability scale（ mRS） 1 months after admission were evaluated in both groups. Results There were no significant differences in the white blood cell count,neutrophils proportion,lymphocytes proportion in peripheral blood,incidence of pulmonary infection NIHSS and mRS between two groups（ P 〈0. 05）. After these patients were redivided into different groups according to whether the patients had pulmonary infection or not,there were no significant differences in the white blood cell count and neutrophils proportion in patients with middle pulmonary infection between two groups（ P 〈0. 05）. However there were significant differences in the white blood cell count and classification in patients without pulmonary infection at the first day of invasion between left side group and right side group（ P 〈0. 05）. The neutrophils proportion in patients without pulmonary infection of left side group reached peak at the first day of invasion,then,which was gradually decreased to normal levels within 1 week,however,which in right side group was transiently increased at the third day of invasion. The lymphocytes proportion in patients without pulmonary infection of left side group was decreased to the lowest levels at the first day of invasion,which was gradually increased to normal levels within 1 week,however,which in right side group was transiently decreased at the third day of invasion（ P 〈0. 05）. Conclusion The change trend of the leucocytes in non- pulmonary infectious patients with acute middle cerebral artery infarction at different sides is quite different, which suggests that the immunosuppressive mechanism caused by acute middle cerebral artery infarction at different sides may be different to some extent.