Shan Wanying, Xu Liang, Xu Yuan, Qiu Zhuoyin, Feng Jie, Zhao Jie, Wang Jingwen
Department of Neurology, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China.
Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Neurol. 2022 Feb 3;12:793435. doi: 10.3389/fneur.2021.793435. eCollection 2021.
The inflammatory response could play a key role in cognitive impairment. However, there has been limited research into the association between total white blood cell (WBC) count and post-stroke cognitive impairment (PSCI), and the significance of leukoaraiosis (LA) in this relationship is unknown. We aimed to examine the total WBC count in relation to PSCI and whether this association was mediated by LA.
Consecutive patients with first-ever ischemic stroke were prospectively enrolled from October 2020 to June 2021. The total WBC count was measured after admission. Cognitive function evaluations were performed at the 3-month follow-up using Mini-mental State Examination (MMSE). We defined the PSCI as an MMSE score <27.
A total of 276 patients (mean age, 66.5 years; 54.7% male) were included in this analysis. Among them, 137 (49.6%) patients experienced PSCI. After adjustment for potential confounders, higher total WBC count was significantly correlated with an increased risk of LA [per 1-SD increase, odds ratio (), 1.39; 95% 1.06-1.82; = 0.017] and PSCI (per 1-SD increase, , 1.51; 95% 1.12-2.04; = 0.006). Furthermore, mediation analysis demonstrated that the association between total WBC count and PSCI was partly mediated by LA (the regression coefficient was changed by 9.7% for PSCI, and 12.4% for PSCI severity, respectively).
Increased total WBC count is a risk factor for PSCI. The presence of LA was partially responsible for the PSCI in patients who had a higher total WBC count.
炎症反应可能在认知障碍中起关键作用。然而，关于全白细胞（WBC）计数与卒中后认知障碍（PSCI）之间关联的研究有限，且白质疏松（LA）在此关系中的意义尚不清楚。我们旨在研究全WBC计数与PSCI的关系，以及这种关联是否由LA介导。
2020年10月至2021年6月前瞻性纳入首次发生缺血性卒中的连续患者。入院后测量全WBC计数。在3个月随访时使用简易精神状态检查表（MMSE）进行认知功能评估。我们将PSCI定义为MMSE评分<27。
本分析共纳入276例患者（平均年龄66.5岁；54.7%为男性）。其中，137例（49.6%）患者发生PSCI。在调整潜在混杂因素后，较高的全WBC计数与LA风险增加显著相关[每增加1个标准差，优势比（）为1.39；95%可信区间为1.06 - 1.82； = 0.017]和PSCI（每增加1个标准差，为1.51；95%可信区间为1.12 - 2.04； = 0.006）。此外，中介分析表明，全WBC计数与PSCI之间的关联部分由LA介导（PSCI的回归系数变化分别为9.7%，PSCI严重程度的回归系数变化为12.4%）。
全WBC计数增加是PSCI的危险因素。LA的存在部分导致了全WBC计数较高患者的PSCI。
