Neurologic Clinic of Medical and Surgical Specialties and Public Health, University of Perugia, Perugia, Italy.
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):819-24. doi: 10.1016/j.jstrokecerebrovasdis.2011.04.015. Epub 2011 Jun 23.
Leukocytes are the first cells that arrive in the stroke region(s), and they increase in peripheral blood. The contribution or leukocytes in the early acute phase of cerebral ischemia has not yet been investigated.
In consecutive first-ever acute ischemic stroke patients whose symptoms had started <12 hours earlier, we aimed to establish whether admission leukocyte count affects the short-term neurologic outcome, and whether there are differences between the various clinical syndromes of stroke. The National Institutes of Health Stroke Scale (NIHSS) was assessed at admission (NIHSS(0)) and after 72 hours (NIHSS(72)). Modified Rankin scale (mRS) scores were evaluated at discharge. The Spearman rank correlation was used for the correlation between leukocytes and outcome measures.
Eight hundred and eleven patients were included (median age 77 years [range 68-82]; 418 [53%] were male; the median NIHSS(0) score was 7 [range 4-12], the median NIHSS(72) score was 6 [range 3-12], and the median mRS score was 2 [range 2-4]). The median leukocyte count at admission was 8100/mm(3) (range 6500-10300). Higher leukocyte levels predicted a worst clinical presentation and a poor functional outcome (NIHSS(0)P < .001; NIHSS(72)P < .001; mRS P < .001). The correlation between leukocyte count and outcome measures remained significant after multivariate analysis (NIHSS(0)P < .001; NIHSS(72)P < .001; mRS P < .008). Focusing on clinical syndromes, a higher leukocyte count predicted severe NIHSS(0) and NIHSS(72) scores in patients with total anterior cerebral stroke (P = .001), partial anterior cerebral stroke (P = .004), or posterior cerebral stroke (P = .026).
An elevated leukocyte count in the acute phase of cerebral ischemia is a significant independent predictor of poor initial stroke severity, poor clinical outcome after 72 hours, and discharge disability. The involved underlying mechanism is still to determined.
白细胞是最早到达中风部位的细胞，并且在外周血液中增加。白细胞在脑缺血的早期急性期中的作用尚未得到研究。
在症状发作<12 小时的连续首次急性缺血性中风患者中，我们旨在确定入院时白细胞计数是否影响短期神经功能结局，以及中风的各种临床综合征之间是否存在差异。入院时（NIHSS(0)）和 72 小时后（NIHSS(72)）评估国立卫生研究院卒中量表（NIHSS）。出院时评估改良 Rankin 量表（mRS）评分。采用 Spearman 秩相关分析白细胞与结局指标之间的相关性。
共纳入 811 例患者（中位年龄 77 岁[范围 68-82]；418[53%]为男性；入院时 NIHSS(0)评分中位数为 7[范围 4-12]，72 小时 NIHSS(72)评分中位数为 6[范围 3-12]，mRS 评分中位数为 2[范围 2-4]）。入院时白细胞计数中位数为 8100/mm(3)[范围 6500-10300]。较高的白细胞水平预示着更差的临床表现和较差的功能结局（NIHSS(0)P<0.001；NIHSS(72)P<0.001；mRS P<0.001）。多变量分析后，白细胞计数与结局指标之间的相关性仍然显著（NIHSS(0)P<0.001；NIHSS(72)P<0.001；mRS P<0.008）。关注临床综合征，在前循环梗死（P=0.001）、部分前循环梗死（P=0.004）或后循环梗死（P=0.026）患者中，较高的白细胞计数预示着严重的 NIHSS(0)和 NIHSS(72)评分。
脑缺血急性期白细胞计数升高是初始卒中严重程度、72 小时后临床结局不良和出院残疾的显著独立预测因素。其潜在的发病机制尚待确定。
