Quan Kehua, Wang Anxin, Zhang Xiaoli, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Front Neurol. 2019 Nov 26;10:1240. doi: 10.3389/fneur.2019.01240. eCollection 2019.
Post-ischemic inflammatory response might be affected by many factors. We chose leukocyte count as a marker of inflammatory response and investigated whether the effects of leukocyte count on the clinical outcomes in acute ischemic stroke patients are different according to different factors. We derived data from the China National Stroke Registry II. Patients with ischemic stroke were classified into four groups by leukocyte count quartiles within the first 24 h after admission. Adverse clinical outcomes were defined as recurrent stroke, all-cause death, and poor functional outcomes (3 ≤ mRS ≤ 5) at 3-months and 1-year follow-up. The subgroup factors were age, sex, history of hypertension, history of diabetes, history of previous stroke, or transient ischemic attack and smoking status. We assessed the association between leukocyte count and adverse clinical outcomes and evaluated this association in different subgroups. A total of 14,678 patients were included. Patients in higher quartiles were likely to be younger, male, smokers, and drinkers, and to have a shorter time from symptom onset to arrival, a more proportion of history of diabetes, atrial fibrillation, and hypertension, and a higher severity of stroke. Higher quartiles were associated with elevated risk of adverse clinical outcomes at 3-months and 1-year follow-up. Leukocyte count had a moderate accuracy to predict clinical outcomes. There was no difference in the relationship between leukocyte count and adverse clinical outcomes across subgroups such as age, sex, history of hypertension, and smoking. The effect of leukocyte count on all-cause death was pronounced among patients with previous stroke or transient ischemic attack, and the effect of leukocyte count on short-term poor functional outcomes was also pronounced among patients without diabetes. Leukocyte count is associated with short-term and long-term clinical outcomes of acute ischemic stroke and may have predictive value, especially in patients with certain specific characteristics.
缺血后炎症反应可能受多种因素影响。我们选择白细胞计数作为炎症反应的标志物，并研究根据不同因素白细胞计数对急性缺血性卒中患者临床结局的影响是否存在差异。我们从中国国家卒中登记二期获取数据。缺血性卒中患者在入院后24小时内按白细胞计数四分位数分为四组。不良临床结局定义为复发性卒中、全因死亡以及在3个月和1年随访时功能结局不佳（改良Rankin量表评分3≤mRS≤5）。亚组因素包括年龄、性别、高血压病史、糖尿病病史、既往卒中或短暂性脑缺血发作病史以及吸烟状况。我们评估了白细胞计数与不良临床结局之间的关联，并在不同亚组中评估了这种关联。共纳入14678例患者。四分位数较高组的患者可能更年轻、为男性、吸烟者和饮酒者，症状发作至就诊时间更短，糖尿病、心房颤动和高血压病史的比例更高，卒中严重程度更高。四分位数较高组与3个月和1年随访时不良临床结局风险升高相关。白细胞计数对预测临床结局具有中等准确性。在年龄、性别、高血压病史和吸烟等亚组中，白细胞计数与不良临床结局之间的关系无差异。白细胞计数对既往有卒中或短暂性脑缺血发作的患者全因死亡的影响显著，对无糖尿病的患者短期功能结局不佳的影响也显著。白细胞计数与急性缺血性卒中的短期和长期临床结局相关，可能具有预测价值，尤其是在具有某些特定特征的患者中。
