Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Front Immunol. 2021 Jul 7;12:709289. doi: 10.3389/fimmu.2021.709289. eCollection 2021.
Blood eosinophil counts are thought to be associated with atherosclerosis in acute ischemic stroke (AIS) and AIS severity. We aimed to investigate 1): the temporal profile of eosinophil in AIS patients treated with recombinant tissue plasminogen activator (r-tPA); 2): The association between dynamic eosinophil and 3-month outcomes in different AIS etiologies; 3): incremental predictive ability of dynamic eosinophil adding to conventional model; and 4): the longitudinal change of neutrophil-to-lymphocyte ratio (NLR) and compared its prognostic value with eosinophils.
A total of 623 AIS patients with intravenous thrombolysis in two hospitals were included. Blood samples were obtained on admission, within 24 h after an intravenous thrombolysis and on the seventh day. A multivariate logistic regression model with restricted cubic spline was performed to explore the association between dynamic eosinophil and a 3-month poor outcome. C-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were adopted to explore the incremental predictive ability.
Percent change in eosinophil counts after intravenous thrombolysis was median -25.00% (IQR -68.25%-+14.29%). Decrease in eosinophil >75% after intravenous thrombolysis was associated with 2.585 times risk for poor outcome and 13.836 times risk for death. However, the association were weak for patients outside of cardioembolic stroke. Adding eosinophil changes to a conventional model improved the discriminatory ability of poor outcome (NRI = 53.3%; IDI = 2.2%) and death (NRI = 101.0%; IDI = 6.9%).
Dynamic decrease in eosinophil after intravenous thrombolysis predicts a 3-month poor outcome and death in AIS patients with r-tPA treatment and improved the predictive ability of conventional model. However, this result needs to be interpreted carefully in non-cardioembolic AIS patients.
血液嗜酸性粒细胞计数被认为与急性缺血性脑卒中（AIS）和 AIS 严重程度有关。我们旨在研究以下内容：1）接受重组组织型纤溶酶原激活剂（r-tPA）治疗的 AIS 患者嗜酸性粒细胞的时间变化；2）动态嗜酸性粒细胞与不同 AIS 病因的 3 个月预后之间的关系；3）动态嗜酸性粒细胞对常规模型的附加预测能力；4）中性粒细胞与淋巴细胞比值（NLR）的纵向变化，并与嗜酸性粒细胞进行比较其预后价值。
共纳入两所医院接受静脉溶栓治疗的 623 例 AIS 患者。在入院时、静脉溶栓后 24 小时内和第 7 天采集血样。采用受限立方样条多元逻辑回归模型探讨动态嗜酸性粒细胞与 3 个月不良预后的关系。采用 C 统计量、净重新分类改善（NRI）和综合判别改善（IDI）评估增量预测能力。
静脉溶栓后嗜酸性粒细胞计数的百分比变化中位数为-25.00%（IQR -68.25%-+14.29%）。静脉溶栓后嗜酸性粒细胞减少>75%与不良预后的风险增加 2.585 倍和死亡的风险增加 13.836 倍相关。然而，对于非心源性栓塞性脑卒中患者，这种关联较弱。将嗜酸性粒细胞变化添加到常规模型中可提高不良预后（NRI = 53.3%；IDI = 2.2%）和死亡（NRI = 101.0%；IDI = 6.9%）的判别能力。
静脉溶栓后嗜酸性粒细胞的动态减少可预测接受 r-tPA 治疗的 AIS 患者 3 个月的不良预后和死亡，并提高常规模型的预测能力。然而，在非心源性栓塞性 AIS 患者中，需要谨慎解释此结果。
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