外周免疫细胞变化与急性脑梗死患者预后关系的研究

Correlation between Changes of Peripheral Immune Cell Number and Outcome in Patients with Acute Brain Infarction

目的探讨急性脑梗死患者外周免疫细胞变化与早期预后的关系。方法收集2014年8月～2016年8月于笔者医院24h内诊断为急性脑梗死患者,收集患者一般临床资料,并在入院后3h内进行相关血液指标检查。采用单因素分析初步筛选影响患者预后的潜在因素,随后利用COX回归分析影响脑梗死预后的独立危险因素,最后采用ROC曲线分析各危险因素在预测脑梗死转归上的诊断价值。并且采用χ2检验以及Kaplan-Meier生存曲线比较一般临床资料、生存结局以及感染发生情况在嗜酸性粒细胞升高及降低组间存在的差异。结果共纳入262例急性脑梗死患者,其中预后不良患者48例。单因素分析结果表明,预后良好组嗜酸性粒细胞、淋巴细胞、中性粒细胞、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、平均血糖水平、C反应蛋白C(C-reactive protein,CRP)含量及平均脑梗死面积是潜在影响患者脑梗死预后的危险因素; COX比例风险模型进一步表明嗜酸性粒细胞减少、中性粒细胞增加及NLR增加均是影响脑梗死患者预后的危险因素(HR=2.15,P=0.031;HR=1.91,P=0.022; HR=3.61,P=0.000); ROC结果显示,中性粒细胞、嗜酸性粒细胞及NLR预测脑梗死患者预后的曲线下面积(area under curve,AUC)分别为0.808、0.748和0.642。并且Kaplan-Meier生存曲线显示,嗜酸性粒细胞减少患者的病死率以及感染率明显高于未减少组。结论嗜酸性粒细胞减少、中性粒细胞增加及NLR增加有潜力成为急性脑梗死患者预后的危险因素,并且嗜酸性粒细胞减少的脑梗死患者脑梗死风险较高。

Objective To investigate the correlation between changes of peripheral immune cell number and outcome in patients with acute brain infarction.Methods The patients with acute cerebral infarction were collected in our hospital for the first 24 hours,and peripheral immune cell number was detected within 3 hours after admission.The general clinical data the serum biochemical parameters were collected.Univariate analysis was used to find the potential risk factors of cerebral infarction patients with poor outcomes,and Cox regression model was further used to identify the independent risk factors.Finally,the ROC curve was used to evaluate the value of these factors in forecasting the outcome of cerebral infarction patients.Furthermore,Chi-square test and Kaplan-Meier survival curve were used to compare the differences of infection rates and survival outcomes between the two groups with or without eosinophilia.Results Totally,262 patients were included in the survey,48 of which had poor prognosis.Univariate analysis showed that the number of neutrophils,eosinophil,neutrophil to lymphocyte ratio(NLR),serum level of glucose,serum level of CRP and cerebral infarction area had potential effects on the prognosis of cerebral infarction patients.COX regression model further revealed that hypoeosinophilia,elevated neutrophils and elevation of NLR level were the independent risk factors of the prognosis of cerebral infarction patients(HR=2.15,P=0.031;HR=1.91,P=0.022;HR=3.61,P=0.000).ROC curve showed that the AUC of number of neutrophils,eosinophil and NLR were 0.808,0.748 and 0.642,respectively.Kaplan-Meier survival curve showed that the mortality and infection rate of patients with eosinopenia were higher than the other groups.Conclusion Hypoeosinophilia,elevated neutrophils and elevation of NLR were novel predictive factor for complications after acute cerebral infarction.Stroke patients with eosinopenia should be monitored carefully for infection.