Ross Amy Miner, Hurn Patricia, Perrin Nancy, Wood Lisa, Carlini Walter, Potempa Kathleen
School of Nursing, Oregon Health & Science University, Ashland, Oregon 97520, USA.
J Stroke Cerebrovasc Dis. 2007 Sep-Oct;16(5):203-7. doi: 10.1016/j.jstrokecerebrovasdis.2007.05.002.
The peripheral inflammatory response, as a proxy for the acute-phase response (a known mechanism for ischemic preconditioning), and non-damage-producing transient ischemia must exist together in humans if this candidate mechanism confers ischemic tolerance. The present study was aimed at determining whether the peripheral inflammatory response (ie, elevated white blood cell, neutrophil, and monocyte counts) exists in transient ischemic attack (TIA) and stroke patients at the time of emergency room admission. The null hypothesis was tested for the variables of the peripheral inflammatory response between the mean of the laboratory normal population versus stroke and TIA patients. A retrospective review of 1041 medical records yielded 12 first-time TIA patients and 34 first-time stroke patients with no confounding evidence of other inflammatory processes. In both groups, neutrophil and monocyte percentages were significantly higher than the laboratory means (in TIA cases: neutrophils, 67.9% [12.67%], P = .001; monocytes, 8.2% [2.7%], P = .020; in stroke cases: neutrophils, 64.9% [9.1%], monocytes, 7.7% [1.6%]; both P < .001). Absolute neutrophil count was significantly higher than the laboratory mean for the stroke cases (5.13 [1.88] K/UL; P = .022). Lymphocyte percentages and absolute lymphocyte count in both groups were significantly and abnormally lower than the laboratory mean (in TIA cases, 21.7% [10.5%] and 1.4 [0.6] K/UL, respectively; in stroke cases, 24.7% [8.4%] and 1.9 [0.7] K/UL, respectively; all P <or= .001). No other absolute counts were significant. These findings suggest that the peripheral inflammatory response exists in transient ischemia, which hypothetically does not damage brain tissue, as well as in stroke (or permanent ischemia), which is known to produce brain tissue damage.
如果这种候选机制能赋予缺血耐受性，那么在人类中，作为急性期反应（一种已知的缺血预处理机制）替代指标的外周炎症反应，与不产生损伤的短暂性缺血必须同时存在。本研究旨在确定短暂性脑缺血发作（TIA）和中风患者在急诊入院时是否存在外周炎症反应（即白细胞、中性粒细胞和单核细胞计数升高）。对实验室正常人群均值与中风和TIA患者外周炎症反应变量进行了无效假设检验。对1041份病历的回顾性研究产生了12例首次发作的TIA患者和34例首次发作的中风患者，且无其他炎症过程的混杂证据。在两组中，中性粒细胞和单核细胞百分比均显著高于实验室均值（TIA病例中：中性粒细胞，67.9%[12.67%]，P = 0.001；单核细胞，8.2%[2.7%]，P = 0.020；中风病例中：中性粒细胞，64.9%[9.1%]，单核细胞，7.7%[1.6%]；两者P < 0.001）。中风病例的绝对中性粒细胞计数显著高于实验室均值（5.13[1.88]K/UL；P = 0.022）。两组中的淋巴细胞百分比和绝对淋巴细胞计数均显著且异常低于实验室均值（TIA病例中分别为21.7%[10.5%]和1.4[0.6]K/UL；中风病例中分别为24.7%[8.4%]和1.9[0.7]K/UL；所有P ≤ 0.001）。其他绝对计数均无显著性差异。这些发现表明，外周炎症反应存在于假设不会损伤脑组织的短暂性缺血中，以及已知会导致脑组织损伤的中风（或永久性缺血）中。
