关键词: 缺血性卒中; 炎症因子; 白细胞; 中性粒细胞; 纤维蛋白原; 预后

Abstract:

Objective To analyze the changes of levels of poststroke inflammatory factors, and its correlation

with neurological function restoration after acute atherosclerotic ischemic stroke. Methods Patients with mild to moderate (NIHSS ≤15 points) acute ischemic stroke due to large vessel atherosclerosis treated in Department of Neurology of Beijing Bo'ai Hospital of China Rehabilitation Research Center from November 2015 to January 2018 were prospectively enrolled in this study. The white blood cell (WBC) count, neutrophils (NEU) count, and the levels of fibrinogen (Fib), IL-6, and TNF-α were detected at admission, 1 week, 2 weeks and 4 weeks after stroke onset, and NIHSS scores were performed at the same time. mRS score was performed at 4 weeks after stroke onset. According to NIHSS score at admission, the patients were divided into two groups: mild stroke (NIHSS 0-4 points) and moderate stroke (NIHSS 5-15 points). The levels of inflammatory factors within 4 weeks were compared between the two groups. The correlation between WBC, NEU counts, the level of Fib and NIHSS score at the same time, and the correlation between WBC, NEU counts and the level of Fib at admission and neurological function restoration during follow-up (NIHSS score at 1 week, 2 weeks and 4 weeks, and mRS at 4 weeks) were analyzed. Results A total of 61 patients were enrolled in the study, including 50 in mild stroke group and 11 in moderate stroke group. WBC count [(8.87±2.99)×109/L vs (7.07±2.06)×109/L, P =0.019], NEU count [(6.38±2.77)×109/L vs (4.72±1.66)×109/L, P =0.010] and the level of Fib [3.31 (2.74-4.24) vs 2.71 (2.36-3.30), P =0.041] in moderate stroke group at admission were higher than those in mild stroke group. At 1 week after onset, WBC count [(8.80±1.47)×109/L vs (6.99±2.32)×109/L, P =0.032], NEU count [(6.16±1.09)×109/L vs (4.72±2.14)×109/L, P =0.049] and the level of Fib [3.73 (2.92- 4.39) vs 2.65 (2.25-3.11), P =0.022] in moderate stroke group were higher than those in mild stroke group. At 2 weeks after onset, WBC count [(8.40±1.68)×109/L vs (6.89±1.28)×109/L, P =0.012], NEU count [(5.76±1.46)×109/L vs (4.59±1.12)×109/L, P =0.024] in moderate stroke group were still higher than that in mild stroke group, but there was no statistical difference in the level of Fib between the two groups. There were no statistical differences in WBC count, NEU count and the level of Fib between the two groups at 4 weeks. There were no statistical differences in the levels of IL-6 and TNF-α between the two groups at each time point. The NIHSS score was positively correlated with the level of Fib at admission (r =0.225, P =0.048), 1 week (r =0.413, P =0.005) and 2 weeks after onset (r =0.382, P =0.034). The NIHSS score was positively correlated with NEU count at admission (r =0.257, P =0.046) and 2 weeks after onset (r =0.396, P =0.027). The NIHSS score was positively correlated with WBC count at 2 weeks after onset (r =0.451, P =0.011). WBC count at admission was positively correlated with NIHSS score at 2 weeks (r =0.442, P =0.007) and 4 weeks (r =0.518, P =0.011); NEU count at admission was positively correlated with NIHSS score at 1 week (r =0.268, P =0.048), 2 weeks (r =0.402, P =0.015) and 4 weeks (r =0.431, P =0.040); the level of Fib at admission was positively correlated with NIHSS score at 1 week (r =0.318, P =0.023) and 2 weeks (r =0.378, P =0.025). Conclusions For mild to moderate ischemic stroke due to large vessel atherosclerosis, the severity of neurological deficit within 2 weeks after onset is positively correlated with the levels of Fib and NEU. The levels of WBC, NEU and Fib in moderate ischemic stroke were higher than those in mild ischemic stroke within 2 weeks after onset, and these differences gradually disappeared at 4 weeks after onset.

Key words: Ischemic stroke; Inflammatory factor; White blood cell; Neutrophil; Fibrinogen;Prognosis