淋巴细胞计数和血小板/淋巴细胞比率与急性缺血性脑血管病的关系研究

Relationship between Lymphocyte Count, Platelet/Lymphocyte Ratio and Acute Ischemic Cerebrovascular Disease

目的分析淋巴细胞计数、血小板/淋巴细胞比率(PLR)与急性缺血性脑血管病的关系。方法选取2014年3月—2016年9月南京中医药大学连云港附属医院神经内科和急诊科收治的急性缺血性脑血管病患者193例,其中短暂性脑缺血发作(TIA)患者65例(TIA组),急性脑梗死(ACI)患者128例(ACI组);另选取同期体检健康者60例作为对照组。随访1个月,根据格拉斯哥预后量表(GOS)评分将ACI患者分为预后良好组98例和预后不良组30例。比较3组受试者血小板计数(PLT)、淋巴细胞计数及PLR,比较不同预后ACI患者临床资料、PLT、淋巴细胞计数及PLR,淋巴细胞计数和PLR与ACI患者GOS评分的相关性分析采用Spearman秩相关性分析。结果 3组受试者PLT比较,差异无统计学意义(P>0.05);ACI组和TIA组患者淋巴细胞计数低于对照组,PLR高于对照组(P<0.05);ACI组患者淋巴细胞计数低于TIA组,PLR高于TIA组(P<0.05)。不同预后ACI患者性别和PLT比较,差异无统计学意义(P>0.05);预后良好组患者年龄小于预后不良组,淋巴细胞计数高于预后不良组,PLR低于预后不良组(P<0.05)。协方差分析结果显示,校正年龄后,预后良好组与预后不良组患者PLT、淋巴细胞计数及PLR比较,差异均无统计学意义(P>0.05)。Spearman秩相关性分析结果显示,淋巴细胞计数与ACI患者GOS评分呈正相关(rs=0.268,P=0.002),PLR与ACI患者GOS评分呈负相关(r_s=-0.336,P<0.001)。结论淋巴细胞计数、PLR可初步鉴别诊断ACI和TIA,且淋巴细胞计数和PLR均与ACI患者短期预后有关。

Objective To analyze the relationship between lymphocyte count,platelet/lymphocyte ratio（ PLR） and acute ischemic cerebrovascular disease. Methods From March 2014 to September 2016, a total of 193 patients with acute ischemic cerebrovascular disease were selected in the Department of Neurology and Emergency,Lianyungang Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,thereinto 65 patients with transient ischemic attack were served as TIA group,other 128 patients with acute cerebral infarction were served as ACI group; meanwhile a total of 60 healthy people were selected as control group. Patients of ACI group were divided into A group（ with good prognosis,n = 98） and B group（ with poor prognosis,n = 30） according to the GOS score after 1-month follow-up. Blood platelet count（ PLT）,lymphocyte count and PLR were compared among the TIA group,ACI group and control group. Clinical data,PLT,lymphocyte count and PLR were compared in acute cerebral infarction patients with different prognosis; correlations lymphocyte count and PLR with GOS score in patients with acute cerebral infarction were analyzed by Spearman rank correlation analysis. Results No statistically significant differences of PLT was found among TIA group,ACI group and control group（ P〉0. 05）; lymphocyte count of ACI group and TIA group was statistically significantly lower than that of control group,respectively,while PLR of ACI group and TIA group was statistically significantly higher than that of control group,respectively（ P〈0. 05）; lymphocyte count of ACI group was statistically significantly lower than that of TIA group,while PLR of ACI group was statistically significantly higher than that of TIA group（ P〈0. 05）. No statistically significant differences of gender or PLT was found between A group and B group（ P〉0. 05）; age of A group was statistically significantly younger than that of B group,lymphocyte count of A group was statistically significantly higher than that of B group,while PLR of A group was statistically significantly lower than that of B group（ P〈0. 05）. Covariance analysis results showed that,no statistically significant differences of PLT,lymphocyte count or PLR was found between A group and B group after correction of age（ P〉0. 05）. Spearman rank correlation analysis results showed that,lymphocyte count was positively correlated with GOS score in patients with acute cerebral infarction（ rs= 0. 268,P = 0. 002）,while PLR was negatively correlated with GOS score in patients with acute cerebral infarction（ rs=-0. 336, P 〈0. 001）.Conclusion Lymphocyte count and PLR have preliminary differential diagnostic value between transient ischemic attack and acute cerebral infarction,meanwhile lymphocyte count and PLR are significantly correlated with short-term prognosis in patients with acute cerebral infarction.