急性脑梗死患者治疗后全血细胞参数及血液流变性指标的变化

背景:血液流变学指标的异常改变与血管损伤、微循环障碍以及血栓的形成和发展具有密切的联系。目的:探讨急性脑梗死患者血液流变学及全血细胞25项参数的变化。设计:同期对照病例分析。单位:新乡医学院医学检验系。对象:①脑梗死组:2002-01/12新乡医学院第二附属医院神经内科收治的急性脑梗死患者127例,均为首发患者,病程4～12h,经头颅CT证实为脑梗死,其诊断标准符合1995年第四届全国脑血管病学术会议修订的各类脑血管病诊断要点。②正常对照组:选择同期在本院体检血压正常,无心、脑、肾疾病及糖尿病的健康人53例。两组年龄、性别比较差异无显著性意义。方法:①脑梗死组患者于入院当天进行降纤治疗,注射2支10u克栓酶,分别于第3,5,7天再次注射1支10u的克栓酶。②两组均用肝素钠抗凝的真空采血管抽取空腹静脉血5mL和EDTA-K2抗凝血2mL,测定切变率分别为200s-1,30s-1,5s-1和1s-1时的全血黏度值、全血高切还原黏度、全血低切还原黏度、全血高切相对指数、全血低切相对指数、血沉方程K值、血浆黏度、红细胞压积、血沉、红细胞聚集指数、红细胞刚性指数、红细胞变形指数、白细胞计数、红细胞计数、平均红细胞体积、红细胞分布宽度、血红蛋白含量、平均红细胞血红蛋白含量、平均红细胞血红蛋白浓度、血小板计数、平均血小板体积、血小板分布宽度。③脑梗死组患者首次检测时间为发病24h内(急性期),并于治疗2周后(恢复期)复查上述指标。主要观察指标:两组血液流变学及全血细胞参数的比较。结果:脑梗死组127例,急性期全部进入结果分析,恢复期有5例患者因出院未能复查。正常对照组53例均无脱落。①与正常对照组比较,除红细胞分布宽度、平均红细胞血红蛋白浓度外,脑梗死组患者急性期各项指标差异均有显著性意义(P<0.05,0.01);脑梗死组患者恢复期的全血低切黏度、全血低切还原黏度、全血高切相对指数、全血低切相对指数、血浆黏度、红细胞压积、红细胞聚集指数、白细胞计数、平均红细胞血红蛋白含量均已恢复到正常水平(P>0.05)。②与急性期比较,脑梗死组患者恢复期红细胞计数、平均血小板体积均明显降低(P<0.05),其余指标基本相似(P>0.05)。结论:急性脑梗死患者存在着血液流变学指标的普遍异常,提示血液流变学及血细胞参数异常可能与脑梗死的发生有关。

Changes of whole hemocyte parameters and hemorrheologic indexes after treatment in patients with cerebral infarction

BACKGROUND: The abnormal changes of hemorrheologic indexes are closely correlated with vascular injury, disorder of microcirculation, thrombosis and its development.OBJECTIVE: To investigate the changes of 25 indexes of hemorheology and whole hemocytes in patients with acute cerebral infarction.DESIGN: A controlled case study.SETTING: Department of Medical Laboratory, Xinxiang Medical College.PARTICIPANTS: Cerebral infarction group: Totally 127 patients with the first attack of acute cerebral infarction were selected from the Department of Neurology, the Second Affiliated Hospital of Xinxiang Medical College from January to December in 2002. The onsetof disease ranged from 4 to 12 hours, and the lesions were confirmed by cranial CT, the diagnostic standard accorded with the diagnostic guidelines for various cerebrovascular diseases formulated by the Fourth National Academic Conference for Cerebrovascular Diseases. Normal control group: Fifty-three healthy physical examinees with normal blood pressure and without diseases of heart,brain and kidney, as well as diabetes mellitus. There were no sigmficant differences in ages and male to femaleratios between the two groups.METHODS: ① Patients in the cerebral infarction group received fibrinogen reduction therapy, they were injected with two pieces of 10 u defibrin on the day of admission, and injected with one piece of 10 u defibrin again on the 3rd, 5th and 7th days respectively. ② Fasting venous blood (5 mL) was drawn with thromboliquine anticoagulated vacuum blood collecting tube,and 2 mL blood was coagulated with EDTA-K2. The whole blood viscosity,whole blood high-sheafing reduction viscosity, whole blood low-shearing reduction viscosity, whole blood high-sheafing relative index, whole blood lowsheafing relative index, equation K value of erythrocyte sedimentation, plasma viscosity, hematocrit, erythrocyte sedimentation, aggregation index of red blood cells (RBC), rigidity index of RBC, deformation index of RBC, counts of while blood cells (WBC) and RBC, mean volume of RBC, mean corpuscular volume (MCV), RBC distribution width (RDW), content of hemoglobin,mean corpuscular hemoglobin content (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were detected when the shear rate was 200 s-1, 30 s-1, 5 s-1 and 1 s-1 respectively. ③ The above indexes of the patients with cerebral infarction were detected within 24 hours after attack (exacerbation) and at two weeks after treatment (recovery period) respectively.MAIN OUTCOME MEASURES: The hemorrheologic and whole hemocyte indexes were compared between the two groups.RESULTS: All of the 127 cases in the cerebral infarction group entered the analysis of results at exacerbation, and 5 of them were not reexamined because of discharge and 122 cases entered the analysis of results at recovery period. All the 53 cases in the normal control group were involved in the analysis of results. ① Except RDW and MCHC, all the other indexes in the patients with cerebral infarction at exacerbation were significantly different from those in the normal control group (P＜0.05, 0.01). As compared with the normal control group, the whole blood low-shearing viscosity, whole blood low-shearing reduction viscosity, whole blood high-sheafing relative index, whole blood low-shearing relative index, plasma viscosity,hematocrit, aggregation index of RBC, WBC count and MCH all returned to normal in the patients with cerebral infarction at recovery period (P＞0.05).② As compared with the exacerbation, the RBC count and MPV were obviously decreased in the patients with cerebral infarction at recovery period (P ＜ 0.05), while the other indexes were similar (P ＞ 0.05).CONCLUSION: Abnormalities of hemorrheologic indexes commonly exist in patients with acute cerebral infarction, which indicates that the abnormalities of hemorrheologic and whole hemocyte parameters may be related to the occurrence of acute cerebral infarction.