Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan Hospital, 20 Geumo-ro, Mulgeum, Yangsan, 50612, Republic of Korea.
Department of Statistics, Hallym University, Chuncheon, Gangwon, Republic of Korea.
Neurol Sci. 2018 Feb;39(2):243-249. doi: 10.1007/s10072-017-3163-7. Epub 2017 Oct 30.
The main features of stroke-induced immunosuppression are lymphopenia and deactivation of monocytes in peripheral blood. We hypothesized that lymphocyte-to-monocyte ratio (LMR) in peripheral blood may represent the degree of stroke-induced immunosuppression. To prove this hypothesis, we evaluated whether LMR is associated with risk of post-stroke infection and clinical outcome at 3 months in patients with acute ischemic stroke. We selected patients with stroke in anterior circulation within 24 h from onset. Peripheral blood sampling for differential blood count was performed on days 1 and 7. The LMRs on days 1 and 7 were analyzed to determine associations with excellent outcomes (modified Rankin Scale of score 0-1 at 3 months). One hundred and two patients were included. The initial National Institutes of Health Stroke Scale score (adjusted odd ratio [OR] 0.89; 95% confidence interval [CI], 0.83-0.95; P = 0.001) and LMR on day 7 (adjusted OR 1.49; 95% CI, 1.09-2.02; P = 0.011) were associated with excellent outcomes. LMRs on day 1 were significantly lower in stroke patients with pneumonia (P = 0.007) and pneumonia or urinary tract infection (P = 0.012) than those without infections. LMRs on day 7 were also significantly lower in stroke patients with infection (P = 0.005 in pneumonia, P = 0.003 in urinary tract infection, and P < 0.001 in pneumonia or urinary tract infection) than those without infections. Lower LMRs on day 7 are associated with worse outcomes at 3 months after stroke onset. LMR may be a useful marker for assessing the stroke-induced immunosuppression.
中风引起的免疫抑制的主要特征是外周血淋巴细胞减少和单核细胞失活。我们假设外周血中淋巴细胞与单核细胞比值（LMR）可能代表中风引起的免疫抑制程度。为了证明这一假设，我们评估了急性缺血性中风患者中风后感染的风险和 3 个月时的临床结局是否与 LMR 相关。我们选择了发病后 24 小时内前循环中风的患者。在发病第 1 天和第 7 天进行外周血白细胞分类计数。分析第 1 天和第 7 天的 LMR，以确定与 3 个月时良好结局（改良 Rankin 量表评分 0-1）的关系。共纳入 102 例患者。初始国立卫生研究院中风量表评分（校正比值比[OR] 0.89；95%置信区间[CI] 0.83-0.95；P=0.001）和第 7 天的 LMR（校正 OR 1.49；95%CI 1.09-2.02；P=0.011）与良好结局相关。患有肺炎（P=0.007）和肺炎或尿路感染（P=0.012）的中风患者第 1 天的 LMR 明显低于无感染的患者。第 7 天的 LMR 也明显低于感染患者（肺炎时 P=0.005，尿路感染时 P=0.003，肺炎或尿路感染时 P<0.001）。第 7 天的 LMR 较低与中风发病后 3 个月的结局较差相关。LMR 可能是评估中风引起的免疫抑制的有用标志物。
