Semerano Aurora, Strambo Davide, Martino Gianvito, Comi Giancarlo, Filippi Massimo, Roveri Luisa, Bacigaluppi Marco
Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy.
Neurology Department, San Raffaele Hospital, Milan, Italy.
Front Neurol. 2020 Apr 3;11:201. doi: 10.3389/fneur.2020.00201. eCollection 2020.
Ischemic stroke patients show alterations in peripheral leukocyte counts that may result from the sterile inflammation response as well as the occurrence of early infections. We here aimed to determine whether alterations of circulating leukocytes in acute ischemic stroke are associated with long-term functional outcome and hemorrhagic complications, independently of the occurrence of infections. Blood laboratory values of patients with acute ischemic stroke, presenting within 4.5 h from symptom onset, were collected. Leukocyte subsets were analyzed in relation to 3-month functional outcome, mortality, and parenchymal hemorrhagic transformation (PH). A multivariable logistic regression analysis, considering the occurrence of early post-stroke infections, was performed for each outcome measure. Five-hundred-ten patients were included in the study. Independently of infections, good functional outcome was associated with a lower neutrophil to lymphocyte ratio (NL-R, OR 0.906 [95% CI 0.822-0.998]), a higher lymphocyte count (OR 1.547 [95% CI 1.051-2.277]), a higher eosinophil count (OR 1.027 [95% CI 1.007-1.048]), and a higher eosinophil to leukocyte ratio (EoLeu-R, OR 1.240 [95% CI 1.071-1.436]) at admission. Death within 3 months was associated with higher NL-R (OR 1.103 [95% CI 1.032-1.179]) as well as with lower eosinophil counts (OR 0.909 [95% CI 0.827-0.999]). Patients developing parenchymal hemorrhagic transformation had higher neutrophil counts (OR 1.420 [95% CI 1.197-1.684]) as well as a higher NL-R (OR 1.192 [95% IC 1.088-1.305]). Leukocyte subtype profiles in the acute phase of ischemic stroke represent a predictor of outcome independently of infections. Stroke-evoked sterile inflammation is a pathophysiological relevant mechanism that deserves further investigation.
缺血性中风患者外周血白细胞计数会发生改变，这可能是由无菌性炎症反应以及早期感染的发生所导致。我们在此旨在确定急性缺血性中风患者循环白细胞的改变是否与长期功能预后及出血性并发症相关，而与感染的发生无关。收集了症状发作后4.5小时内就诊的急性缺血性中风患者的血液实验室检查值。分析白细胞亚群与3个月功能预后、死亡率及实质出血性转化（PH）的关系。针对每个预后指标进行了多变量逻辑回归分析，同时考虑了中风后早期感染的发生情况。该研究共纳入510例患者。与感染无关，良好的功能预后与入院时较低的中性粒细胞与淋巴细胞比值（NL-R，比值比[OR]0.906[95%置信区间（CI）0.822 - 0.998]）、较高的淋巴细胞计数（OR 1.547[95%CI 1.051 - 2.277]）、较高的嗜酸性粒细胞计数（OR 1.027[95%CI 1.007 - 1.048]）以及较高的嗜酸性粒细胞与白细胞比值（EoLeu-R，OR 1.240[95%CI 1.071 - 1.436]）相关。3个月内死亡与较高的NL-R（OR 1.103[95%CI 1.032 - 1.179]）以及较低的嗜酸性粒细胞计数（OR 0.909[95%CI 0.827 - 0.999]）相关。发生实质出血性转化的患者中性粒细胞计数较高（OR 1.420[95%CI 1.197 - 1.684]）以及NL-R较高（OR 1.192[95%CI 1.088 - 1.305]）。缺血性中风急性期的白细胞亚型谱代表了一种独立于感染的预后预测指标。中风引发的无菌性炎症是一种值得进一步研究的病理生理相关机制。
