Cavrak Megan E, Hass Rotem, Stephens Ronald J, Adcock Amelia, Petrone Ashley B
Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, USA.
Neurology, West Virginia University School of Medicine, Morgantown, USA.
Cureus. 2021 Feb 16;13(2):e13383. doi: 10.7759/cureus.13383.
Introduction The differential diagnosis of transient ischemic attack (TIA) versus mild acute ischemic stroke (AIS) during the initial presentation to the emergency department is often difficult, as the diagnosis of both TIA and AIS relies on the presence of focal neurologic signs. As such, roughly 50% of patients with transient or mild neurologic deficits have an uncertain diagnosis prior to neuroimaging. Biomarkers, particularly leukocyte biomarkers, may be used by clinicians to diagnose mild AIS prior to neuroimaging, and this study is the first to describe the use of leukocyte biomarkers for the differentiation of mild AIS, TIA, and stroke mimic. Methods We performed a retrospective chart review of patients discharged from a local hospital with a discharge diagnosis of either TIA or AIS. Past medical history and complete blood cell count with differential upon admission were collected for all subjects. Statistical analyses were performed to compare immune cell parameters between the two groups. For all comparisons, logistic regression analysis was used to assess the effect of confounding variables, such as age, gender, and medical history for each study variable. Results Of all the immune parameters assessed in this study, the neutrophil percentage was the only significant biomarker that significantly differed between study groups. After adjustment for confounding variables using stepwise logistic regression, mild AIS patients were 5.3 times more likely than TIA cases to have a neutrophil percentage above the normal range. Conclusion Our results suggest that clinicians may utilize neutrophil percentage as an additional piece of information that may aid in their diagnosis of mild AIS versus TIA.
引言 在初次就诊于急诊科时，短暂性脑缺血发作（TIA）与轻度急性缺血性卒中（AIS）的鉴别诊断往往很困难，因为TIA和AIS的诊断都依赖于局灶性神经体征的存在。因此，大约50%有短暂或轻度神经功能缺损的患者在进行神经影像学检查之前诊断不明确。生物标志物，尤其是白细胞生物标志物，临床医生可用于在神经影像学检查之前诊断轻度AIS，本研究首次描述了白细胞生物标志物在区分轻度AIS、TIA和疑似卒中方面的应用。方法 我们对一家当地医院出院诊断为TIA或AIS的患者进行了回顾性病历审查。收集了所有受试者的既往病史和入院时的全血细胞计数及分类。进行统计分析以比较两组之间的免疫细胞参数。对于所有比较，使用逻辑回归分析评估混杂变量（如年龄、性别和每个研究变量的病史）的影响。结果 在本研究评估的所有免疫参数中，中性粒细胞百分比是研究组之间唯一有显著差异的重要生物标志物。使用逐步逻辑回归对混杂变量进行调整后，轻度AIS患者中性粒细胞百分比高于正常范围的可能性是TIA患者的5.3倍。结论 我们的结果表明，临床医生可以将中性粒细胞百分比作为一项额外信息，可能有助于他们诊断轻度AIS与TIA。
