Ying AnNa, Cheng YaNi, Lin YanYan, Yu JunRu, Wu XiaoYun, Lin YuanShao
Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Neurol Sci. 2020 Aug;41(8):2215-2223. doi: 10.1007/s10072-020-04324-6. Epub 2020 Mar 16.
The higher level of neutrophil on admission has been reported to predict worse 3-month outcomes in ischemic stroke patients. Our study was to explore the dynamic changes of neutrophil and lymphocyte after r-tPA thrombolysis of ischemic stroke and the relationship with parenchymal hemorrhage (PH) and 3-month function outcome.
A total of 208 acute ischemic stroke (AIS) patients with intravenous thrombolysis were included and then received 3-month follow-up in the present study. Blood samples for neutrophil and lymphocyte counts were obtained on admission, at 24 h and at 7 days after r-tPA infusion. The associations of increase in neutrophil, lymphocyte, and neutrophil to lymphocyte ratio (NLR) with PH or 3-month poor outcome were examined by logistic regression.
Increasing trends in the neutrophil and NLR were observed in AIS patients after r-tPA treatment. Increased level of neutrophil at 24 h after r-tPA infusion but not that on admission was associated with PH (OR = 2.86, P = 0.029) and 3-month poorer functional outcomes (OR = 2.67, P = 0.009). Moreover, patients were divided into four groups according to the percent change in neutrophil within 24 h following r-tPA treatment, and we found that there was a trend of incremental OR when compared higher increase group with lower ones.
Dynamic increase in neutrophil and NLR after stroke may predict PH and 3-month poor outcome in AIS patients receiving r-tPA treatment. Therefore, neutrophil and NLR may serve as activity markers for PH and 3-month poor prognosis in AIS patients with intravenous thrombolysis.
据报道，缺血性中风患者入院时较高的中性粒细胞水平预示着3个月时的预后较差。我们的研究旨在探讨缺血性中风患者接受重组组织型纤溶酶原激活剂（r-tPA）溶栓后中性粒细胞和淋巴细胞的动态变化及其与脑实质出血（PH）和3个月功能结局的关系。
本研究共纳入208例接受静脉溶栓的急性缺血性中风（AIS）患者，并对其进行3个月的随访。在入院时、r-tPA输注后24小时和7天时采集血液样本进行中性粒细胞和淋巴细胞计数。通过逻辑回归分析中性粒细胞、淋巴细胞及中性粒细胞与淋巴细胞比值（NLR）升高与PH或3个月不良结局之间的关联。
r-tPA治疗后AIS患者中性粒细胞和NLR呈上升趋势。r-tPA输注后24小时中性粒细胞水平升高而非入院时升高与PH（比值比[OR]=2.86，P=0.029）和3个月时较差的功能结局（OR=2.67，P=0.009）相关。此外，根据r-tPA治疗后24小时内中性粒细胞的变化百分比将患者分为四组，我们发现与较低升高组相比，较高升高组的OR有增加趋势。
中风后中性粒细胞和NLR的动态升高可能预示接受r-tPA治疗的AIS患者发生PH和3个月时预后不良。因此，中性粒细胞和NLR可作为接受静脉溶栓的AIS患者发生PH和3个月预后不良的活性标志物。
