入院当日白细胞状况对急性缺血性脑卒中出院当日MRS评分的影响

目的探讨入院当日白细胞计数和中性粒细胞比率对急性缺血性脑卒中(AIS)患者出院当日MRS评分的影响,为科学评估住院期间病情转归提供依据。方法采用回顾性队列研究的方法,录入2011.6.1-2014.6.1阜新市中心医院3151例AIS患者,收集人口统计学、生活方式及入院当日白细胞计数,中性粒细胞比率等血常规信息。出院当日按照生活质量评分量表(MRS)评分将研究对象分为2组:MRS≥3分为神经功能缺损组,MRS3分为对照组。按照白细胞计数(≤10.0×10~9·L~(-1),10.1～11.0×10~9·L~(-1),11.1～12.0×10~9·L~(-1),≥12.1×10~9·L~(-1))水平将研究对象分为4组,按照中性粒细胞比率(≤70.00%,70.01-80.00%,≥80.01%)将研究对象分为3组,采用Logistic回归分析白细胞计数及中性粒细胞比率对AIS出院当日MRS评分的影响。结果 MRS≥3分组的白细胞计数、中性粒细胞比率均高于MRS3分组,差异有统计学意义(P0.05);经多因素校正后,白细胞计数与第1组相比,第2、3和4组均增加了AIS发生MRS评分增高神经功能缺损的风险,OR值及95%CI分别为1.700(1.103～2.620),2.756(1.714～4.433),3.355(2.453～4.589);中性粒细胞比率与第1组相比,第2和3组均增加了AIS患者MRS评分增高神经功能缺损的风险;并且随着白细胞计数和中性粒细胞比率的增加,残疾和死亡复合结局的风险也随着增加(P趋势性检验0.0001)。结论 AIS患者入院当日白细胞计数增加及中性粒细胞比率升高加大了出院当日MRS评分增高的风险,并存在计量反应关系。     

高血压脑出血急性期白细胞反应及临床意义

目的 探讨高血压脑出血急性期白细胞总数及中性粒细胞计数与脑出血血肿大小、预后的关系及意义。方法 测定104例急性期高血压脑出血外周血白细胞总数及中性粒细胞计数，根据头部CT扫描计算血肿大小，临床疗效评定标准判断预后，将白细胞总数、中性粒细胞计数与血肿大小、临床结果进行分析。结果 高血压脑出血外周血白细胞总数、中性粒细胞计数与血肿大小呈显著相关性，死亡组白细胞总数及中性粒细胞计数较存活组有明显升高。结论 脑出血外周血白细胞总数及中性粒细胞计数可作为判断病情及临床预后的指标之一。     

脑出血急性期血常规参数的变化与预后的关系

目的分析脑出血急性期血常规参数的变化与预后的关系。方法将103例脑出血急性期患者纳入研究,30例健康检查者为正常组。脑出血急性期患者分组:按出血情况不同分为血肿扩大组、并发脑室出血组、出血量30mL组、出血量≥30mL组,对比淋巴细胞计数、白细胞计数、中性粒细胞计数;按格拉斯哥昏迷指数(GCS)分为重度组、中度组和轻度组,对比急性期不同时间白细胞计数和中性粒细胞计数;按预后分为死亡、不良和良好组,对比白细胞计数和中性粒细胞计数。使用Logistic回归分析中性粒细胞、白细胞与脑出血急性期预后的关系及预测预后有效率。结果出血量30mL组淋巴细胞与正常组差异无统计学意义(P0.05),脑出血组白细胞、中性粒细胞计数与对照组比较差异有统计学意义(P0.05);并发脑室出血患者中性粒细胞计数及白细胞计数均明显高于出血量30 mL患者(P0.05),但淋巴细胞计数差异无统计学意义(P0.05)。入院时、入院后3d、7d,轻、中、重组白细胞计数及中性粒细胞计数差异有统计学意义(P0.05),治疗15d这种差异消失。死亡者白细胞计数及中性粒细胞计数最高(P0.05)。脑积血患者白细胞计数上升77.14%,中性粒细胞上升71.43%。结论脑出血急性期外周血白细胞计数和淋巴细胞计数不仅与病情严重程度有关,还与出血量、治疗时间相关,是评估预后的重要指标。     

高血压脑出血急性期白细胞反应及临床意义

目的　探讨高血压脑出血急性期白细胞总数及中性粒细胞计数与脑出血血肿大小、预后的关系及意义。方法　测定10 4例急性期高血压脑出血外周血白细胞总数及中性粒细胞计数 ,根据头部CT扫描计算血肿大小 ,临床疗效评定标准判断预后 ,将白细胞总数、中性粒细胞计数与血肿大小、临床结果进行分析。结果　高血压脑出血外周血白细胞总数、中性粒细胞计数与血肿大小呈显著相关性 ,死亡组白细胞总数及中性粒细胞计数较存活组有明显升高。结论　脑出血外周血白细胞总数及中性粒细胞计数可作为判断病情及临床预后的指标之一     

急性脑卒中早期外周血白细胞计数变化及其临床意义的研究

目的研究急性脑卒中发病早期外周血白细胞计数的变化及其临床意义．方法对126例急性脑出血和脑梗塞患者进行发病早期外周血白细胞计数，并观察其与意识障碍及疾病转归的关系。结果脑出血和脑梗塞患者意识障碍组和死亡组白细胞计数均值及中性粒细胞比例均较各自神志清楚组和生存组增高，白细胞计数增高组意识障碍发生率和近期病死率均明显高于各自白细胞计数正常组．结论早期外周血白细胞计数可作为急性脑卒中病情观察和预后判断的参考因素之一，为临床合理治疗提供参考．     

脑出血后外周血白细胞计数变化与预后的相关性研究

目的探讨患者脑出血后外周血白细胞计数变化与预后的相关性。方法对2013-01—2016-06在我院神经内科治疗的560例急性脑出血患者的临床资料进行回顾性分析。入院12h后行神经功能缺损评分,其中0~15分249例为轻型组,16~30分201例为中型组,31~45分110例为重型组。所有患者在入院后24h内采集外周血,采用西门子全自动血细胞分析仪计数白细胞及中性粒细胞。比较不同预后患者白细胞及中性粒细胞平均升高率,比较不同神经功能缺损评分患者在入院时、入院后第3天、第7天及第14天外周白细胞水平,比较不同意识患者白细胞及中性粒细胞水平。结果重型组入院时外周白细胞计数水平最高,其次是中型组,3组间比较差异有统计学意义(P0.01)。入院后随着治疗时间的延长,各组白细胞计数均呈下降趋势(P0.05);但重型组及中型组在第3天、第7天、第14天的白细胞计数仍显著高于轻型组,差异有统计学意义(P0.05)。意识障碍患者白细胞计数及中性粒细胞比例显著高于意识清醒患者,差异有统计学意义(P0.05)。死亡患者白细胞计数平均升高率及中性细胞升高率显著高于存活组,差异有统计学意义(P0.05)。结论急性脑出血后患者外周血白细胞水平与患者病情以及预后有密切关系,临床上可以根据白细胞计数判断患者病情,评估预后。     

急性脑血管病的白细胞计数与中性粒细胞趋化功能的研究

本文对３９例急性脑血管病患者的白细胞计数和中性粒细胞趋化功能进行了研究。与对照组相比，急性期白细胞计数显著增高（Ｐ＜０．０５）．白细胞数与脑梗塞面积（或出血量）成正相关（ｒ＝０．４５，Ｐ＜０．０１）．中性粒细胞趋化功能低于正常对照组（Ｐ＜０．０５）．结果提示白细胞的异常与脑血管病病理生理机制有某种内在联系，本研究对脑血管病患者易于合并感染且难于控制提供一种解释。     

抗抑郁剂与抑郁症患者白细胞减少相关性研究

目的探讨抑郁症患者抗抑郁剂治疗与白细胞减少的关系。方法病例组为符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的抑郁症患者,入组后分别予艾司西酞普兰、帕罗西汀、米氮平、舍曲林单药治疗4周,采用血细胞分析仪分别测定正常对照组及病例组治疗前、治疗2周、治疗4周的白细胞及中性粒细胞计数。结果对照组与病例组治疗前白细胞、中性粒细胞计数差异无统计学意义(P0.05);艾司西酞普兰组治疗前与治疗4周中性粒细胞计数分别为(3.75±1.30)*109/L、(3.34±1.12)*109/L,差异有统计学意义(t=2.16,P=0.03);其余病例组治疗前后白细胞、中性粒细胞计数比较差异无统计学意义(P0.05)。结论艾司西酞普兰可能在一定程度上降低抑郁症患者中性粒细胞数量。     

急性脑出血后中性粒细胞与淋巴细胞比值在预测患者神经功能恶化中的价值研究

目的探讨外周免疫细胞亚群计数及中性粒细胞与淋巴细胞比值(NLR)在预测急性脑出血(AICH)后神经功能恶化(ND)的价值。方法分析本院收治的87例AICH患者的临床资料。根据AICH后1w内有无ND进展将患者分为神经功能恶化组(ND组24例,占27.6%)和无神经功能恶化组(非ND组63例,占72.4%),并比较2组患者在入院时的外周免疫细胞亚群计数、NLR比值的差异性及与ND发生的相关性。结果 ND组患者的白细胞计数、中性粒细胞计数均高于非ND组患者,分别为10.80±4.44vs8.02±2.24(P0.001)和9.23±4.97vs5.02±1.87(P0.001),而淋巴细胞计数低于非ND组患者1.45±0.58vs2.43±1.87(P=0.025),故ND组患者的NLR比值明显高于非ND组患者9.45±5.40vs3.28±1.94(P0.001)。通过回归分析发现AICH后外周血细胞计数、NLR比值与ND的发生密切相关(OR:1.87,95%CI:1.45~2.23),P0.001)。根据ROC曲线下面积证实NLR比值(面积为0.872,P0.001)对ND发生的预测价值高于白细胞计数、中性粒细胞和淋巴细胞计数(面积分别为0.749,0.823和0.721,均P0.001)。结论 NLR比值的升高对预测AICH后ND的发生具有重要的临床价值,能够为AICH患者的预后管理提供理论依据。     

急性脑卒中患者中性粒细胞L-选择素(CD62L)的表达及意义

近年来，基础研究越来越重视白细胞对脑卒中发病的作用。许多研究表明，白细胞激活及与内皮细胞黏附是脑卒中发展过程中的关键因素。脑卒中急性期，大多数患者外周血白细胞增多，而且中性粒细胞计数升高程度明显高于白细胞总数，L-选择素(CD62L)作为黏附过程中循环中性粒细胞表达的重要黏附分子，其介导的中性粒细胞的滚动是中性粒细胞与内皮细胞形成牢固黏附的前提条件。该研究采用流式细胞术(FCM)测定急性脑卒中患者中性粒细胞表面CD62L的表达并探讨其临床意义。     

白细胞在实验性脑缺血中作用及中药川芎嗪和丹皮酚对其影响的研究

目的　研究沙鼠脑缺血后再灌注期周围血白细胞 (WBC)、脑实质中小胶质细胞和WBC数的变化规律及中药川芎嗪、丹皮酚对其的影响。　　方法　建立沙鼠脑缺血及再灌注模型 ,取周围血行WBC计数 ,脑组织切片在光镜下行WBC及小胶质细胞计数。　　结果　周围血WBC数在再灌注 4h升高 ,至 1 2h达到高峰 ,以中性粒细胞 (NC)增多为主 ;脑实质中小胶质细胞于再灌注 4h达到高峰 ,WBC在再灌注 2 4h增多最明显 ;川芎嗪、丹皮酚均可降低脑缺血再灌注后增加的周围血WBC数 ,亦能使脑实质中小胶质细胞和WBC数明显减少 ,　　结论　白细胞、小胶质细胞在脑缺血时明显增多 ,丹皮酚、川芎嗪能减少增多的白细胞和小胶质细胞。     

外周血白细胞与急性缺血性卒中的相关性研究

目的探讨外周血早期白细胞及其亚型与急性缺血性卒中(AIS)发生、发展的关系。方法连续收集AIS住院患者588例,性别和年龄匹配的非脑卒中患者630例,比较2组患者的临床资料并进行多元Logistic回归分析。根据头颅CT或MRI梗死面积大小将AIS患者分为腔隙性AIS组151例和非腔隙性AIS组437例,比较2组白细胞参数并进行多元Logistic回归分析。结果 AIS组白细胞、中性粒细胞及中性粒细胞/淋巴细胞比值(NLR)高于对照组,差异有统计学意义(P0.05);Logistic回归分析显示,白细胞计数(OR=1.073,95%CI:1.017~1.132,P=0.009)和中性粒细胞计数(OR=1.068,95%CI:1.001~1.139,P=0.046)进入回归方程。非腔隙性AIS组白细胞计数高于腔隙性AIS组,差异有统计学意义(P0.05);Logistic回归分析显示,白细胞计数(OR=0.898,95%CI:0.811~0.995,P=0.040)进入回归方程。结论白细胞和中性粒细胞升高是AIS的独立危险因素,低白细胞计数为腔隙性AIS的危险因素,白细胞计数对AIS的发生及梗死面积具有一定的预测价值。     

白细胞在实验性脑缺血中的变化和中药川芎嗪、丹皮酚对其影响

制成沙鼠脑缺血后再灌注动物实验模型,研究脑缺血后再灌注不同时期周围血WBC计数和分类、脑实质中小胶质细胞和WBC数的变化规律,并应用中药川芎嗪、丹皮酚治疗。结果发现,沙鼠周围血WBC数在4h开始升高,至12h达到高峰;脑实质中小胶质细胞于4h达到高峰、WBC则在24h增多至最高峰;川芎嗪、丹皮酚均可降低脑缺血再灌注后增加的周围血WBC数,亦能使脑实质中小胶质细胞和WBC数明显减少。     

多发性硬化患者外周血和脑脊液淋巴细胞亚群的观察

用碱性磷酸酶抗酸酶法检查了４６例多发性硬化活动期患者外周血和脑脊液的淋巴细胞亚群。结果显示：活动期ＭＳ者外周血ＣＤ＾＋４，ＣＤ＾＋９细胞较对照组减少，ＣＤ＾＋２５细胞，ＣＤ＾＋４／ＣＤ＾＋８比值较对照组升高。ＣＳＦ中ＣＤ＾４，ＣＤ＾＋２５细胞，ＣＤ＾＋４／ＣＤ＾＋８比值较对照组升高，ＣＤ＾＋８细胞降低，且ＣＳＦ中淋巴亚群均高于自身外周血中的相应细胞。     

Circadian rhythm of neutrophil counts and granulocyte macrophage-colony stimulating factor (GM-CSF) under clozapine treatment: A case report

Agranulocytosis is a severe side effect of clozapine which requires stopping this medication immediately in the case of progressive neutropenia. There are, however, cases of benign neutropenia under clozapine that do not progress. The ability to predict progression vs. non-progression in neutropenia cases under clozapine would be highly valuable for avoiding unnecessary treatment withdrawals. In this context, we closely monitored circadian neutrophil counts and granulocyte macrophage-colony stimulating factor (GM-CSF) levels in a patient who had low normal neutrophil counts at baseline and developed neutropenia under clozapine treatment. Methods. Venous blood samples were drawn in close intervals for 4 weeks. At several time points blood was sampled in the morning between 08:30 and 9:30 h and a second time in the afternoon between 14:00 and 15:00 h. Results. The circadian rhythm of neutrophil counts and GM-CSF levels was unchanged. There was no progression to agranulocytosis, and clozapine could be continued. Conclusions. In view of the available literature and the presented case it is suggested that further studying of circadian profiles of neutrophil counts, neutrophil regulatory factors, such as GM-CSF, and their intercorrelation may help to find a biomarker of benign vs. malign neutropenia under clozapine.     

Role of submandibular salivary glands in LPS-induced lung inflammation in rats

OBJECTIVE: Literature data suggest that rodent salivary glands can exert a neuroimmunomodulatory influence on distant inflammatory events. The release of regulatory factors by salivary glands appears to be influenced by time-dependent factors. In this paper we examined this possibility directly by studying the role of submandibular salivary glands in the temporal profile of lypopolysaccharide (LPS)-induced lung inflammation in rats. METHODS: The submandibular glands were removed (SMGx) or not (sham) and, 4 days later, the animals received an intravenous LPS injection (Salmonella abortus equi, 1 mg/kg). Cells in peripheral blood and in bronchoalveolar and bone marrow lavages were quantified after 90 min, 1, 3 and 5 days. Tumor necrosis factor (TNF) activity and corticosterone concentrations in serum were also determined. Baseline values were determined in a group of na?ve rats. RESULTS: One day after the LPS injection, neutrophil counts in lungs and blood in both animal groups were elevated, but the SMGx rats presented a significantly lower response in comparison to the sham-operated controls. Five days after LPS treatment, however, SMGx rats had higher neutrophil counts in the lungs than did sham animals, but numbers of blood neutrophils were equal. Ninety minutes after LPS injection, a peak of serum TNF activity was detected in both groups compared with na?ve levels. At this time point, TNF activity was about 135% higher in the serum of the SMGx group than in controls. Corticosterone levels of sham-operated controls rose only on the 5th day after LPS, whereas SMGx rats had significant peaks of corticosterone both on the 1st and the 5th day, but not on the 3rd day. CONCLUSION: Our data indicate that submandibular glands have a dual effect on inflammatory pulmonary response by differentially modulating the profile of lung neutrophil influx.     

TGF-β1 post-treatment in a rabbit model of cerebral ischaemia

Abstract

Transforming growth factor-β1 (TGF-β1), suggested in some studies to suppress astrocyte and neutrophil function, has also reduced ischaemic brain injury when administered immediately prior to clot embolization in models of thromboembolic stroke. The effect of TGF-β1 as a post-treatment paradigm was investigated in a rabbit model of thromboembolic stroke. Following clot embolization, regional cerebral blood flow fell to<10 cc 100 g^–1 min^–1 in all animals. TCF-β1 (10 jug) or vehicle (n = 5 each group) was infused via the contralateral carotid artery. TGF-β1 administration resulted in a rapid and selective reduction in the peripheral neutrophil count as compared to a significant (p<0.05) increase in control values (2336 ± 817 vs 4320 ± 928 neutrophils mm , mean ± SEM). Neutrophil aggregation was increased within 30 min of TGF-β1 infusion when compared to control (2.07 ± 0.70 vs 1.09 ± 0.17 ohms, p<0.05); neutrophil chemiluminescence, an index of the oxygen respiratory burst was not significantly affected by TGF-β1 administration. No difference in platelet counts or aggregation was noted. There was no significant difference between the two groups regarding brain infarct size (47.5 ± 10.9 vs 56.5 ± 10.4, n = 4, TGF-β vs control, mean ± SEM), intracranial pressure, or brain excitatory amino acid levels (aspartate and glutamate) within ischaemic regions. It is concluded from the present study that 1. infusion of TGF-β1 as a post-treatment paradigm affords only a modest reduction in ischaemic brain injury in this rabbit model of thromboembolic stroke; 2. TGF-β1 functions as a pure chemo-attractant as determined by both the reduction of peripheral neutrophil count and an associated increased aggregation response without evidence of concomitant activation, the latter examined by luminol-dependent chemiluminescence. Although a small increase in neutrophil accumulation was noted in ischaemic regions of the group receiving TGF-β1 (1.87 vs 1.61 x 107 neutrophils g^–1 tissue), further studies are necessary to define the site(s) and significance of neutrophil sequestration in ischaemic tissues following TGF-β1 administration. [Neurol Res 1994; 16: 465–470]     

Leukocyte regulation in depression and schizophrenia

The distribution of leukocytes in the blood stream is affected by levels of circulatory glucocorticoids. Elevated concentrations of cortisol are usually associated with an increase in the number of neutrophils and a decrease in the number of lymphocytes. Since primary depressive illness is often associated with hypercortisolemia, we hypothesized that similar changes in the blood stream of depressive patients may occur. To test this hypothesis, we retrospectively compared leukocyte counts in 177 untreated depressive patients and 178 untreated schizophrenic controls. We found a significant increase in the absolute and relative numbers of neutrophils and a significant decrease in the absolute and relative numbers of lymphocytes in the depressive group. Furthermore, when compared to normative values from the general population, depressed patients showed higher frequencies of both neutrophilia and lymphopenia than the schizophrenic group. These results indicate differences in the regulation of leukocytes in depression and schizophrenia consistent with the effects of higher levels of plasma cortisol in the depressive group.     

Interferon responses of leukocytes in multiple sclerosis

In vitro interferon (IFN) responses of peripheral blood leukocytes to measles virus and to other IFN inducers were determined for multiple sclerosis patients and normal donors. The group mean IFN response to measles virus was significantly lower in patients (15 units) than in normal donors (100 units), and a greater proportion of the patients failed to exhibit a significant IFN response. This defect was not specific for measles virus and was also observed consistently in response to Newcastle disease virus, Poly(I).Poly(C), and concanavalin A. The level of IFN response was not related to the clinical stage of disease.