作者：吴宇鹏，孙梦飞，傅聪，吴梅，宗海亮，马庆防，傅新民

单位：

1.蚌埠医学院研究生院2.江苏省徐州市中心医院神经内科3.江苏省泰州市人民医院病理科4.江苏省徐州市中心医院神经外科

Units：

1.Graduate School of Bengbu Medical College, Bengbu 233000, China 2.Department of Neurology, Xuzhou Central Hospital, Xuzhou 221009, China 3.Department of Pathology, Taizhou People's Hospital, Taizhou 225300, China 4.Department of Neurosurgery, Xuzhou Central Hospital, Xuzhou 221009, China

关键词：

卒中; 急性缺血性脑卒中; 血管内治疗; 血栓; 白细胞; 预后;

Keywords：

Stroke; Acute ischemic stroke; Endovascular therapy; Thrombosis; Leukocytes; Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.145

Funds：

江苏省中医药科技发展计划项目（MS2021049）

摘要：

目的 探讨急性缺血性脑卒中（AIS）患者血栓中白细胞分布情况及其对血管内治疗预后的影响。方法回顾性选取2021年1月至2022年10月于徐州市中心医院高级卒中中心接受血管内治疗的AIS患者90例为研究对象。收集患者临床资料，根据血栓中白细胞分布情况将血栓分为白细胞散在组及白细胞成簇组，出院时采用改良Rankin量表（mRS）评估患者预后；比较白细胞散在组与白细胞成簇组临床资料，采用单因素及多因素Logistic回归分析探讨AIS患者血管内治疗预后的影响因素。结果 纳入的90例患者中6例因血栓染色等技术原因未获得病理结果，最终纳入84例患者，其中白细胞散在组36例（42.9%）、白细胞成簇组48例（57.1%）。两组年龄、发病至血管再通时间、取栓次数、行静脉溶栓者占比比较，差异有统计学意义（P<0.05）。预后良好26例，预后不良58例。单因素Logistic回归分析结果显示，高血压病史、术前美国国立卫生研究院卒中量表（NIHSS）评分、手术时间、取栓次数可能是AIS患者血管内治疗预后的影响因素（P<0.05）。多因素Logistic回归分析结果显示，术前NIHSS评分、手术时间是AIS患者血管内治疗预后的影响因素（P<0.05）。结论 57.1%的AIS患者血栓中白细胞成簇分布，AIS患者年龄、发病至血管再通时间、取栓次数、行静脉溶栓可能与血栓中白细胞分布情况相关；术前NIHSS评分、手术时间是AIS患者血管内治疗预后的影响因素，暂未发现血栓中白细胞分布情况对AIS患者血管内治疗预后有影响。

Abstract：

　Objective To investigate the distribution of leukocytes in thrombus of patients with acute ischemic stroke (AIS) and its impact on the prognosis of endovascular therapy. Methods A total of 90 AIS patients who received endovascular therapy at the Advanced Stroke Center of Xuzhou Central Hospital from January 2021 to October 2022 were retrospectively selected as the research objects. Clinical data of patients were collected, the thrombus were divided into leukocyte-scattered group and leukocyte-clustered group based on the distribution of leukocytes in thrombus, the prognosis of patients was evaluated by modified Rankin Scale (mRS) at discharge. Clinical data were compared between leukocyte-scattered group and leukocyte?clustered group, univariate and multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis of endovascular therapy in AIS patients. Results Among the included 90 patients, 6 did not obtainpathological results due to technical reasons such as thrombus staining, ultimately 84 patients were included, including 36 cases (42.9%) in the leukocyte?scattered group and 48 cases (57.1%) in the leukocyte-clustered group. There were significant differences in age, time from onset to recanalization, number of thrombectomy attempts, and proportion of patients receiving intravenous thrombolysis between the two groups (P < 0.05) . There were 26 cases with good prognosis and 58 cases with poor prognosis. Univariate Logistic regression analysis showed that the history of hypertension, preoperative National Institute of Health Stroke Scale (NIHSS) score, operative time, and number of thrombectomy attempts may be the influencing factors of prognosis of endovascular therapy in AIS patients (P < 0.05) . Multivariate Logistic regression analysis showed that preoperative NIHSS score, operative time were influencing factors of prognosis of endovascular therapy in AIS patients (P < 0.05) . Conclusion Fifty-seven point one percent of AIS patients have leukocyte-clustered in thrombus. Age, time from onset to recanalization, number of thrombectomy attempts, and intravenous thrombolysis may be related to the distribution of leukocytes in thrombus of patients with AIS. Preoperative NIHSS score, operative time are influencing factors of prognosis of endovascular therapy in AIS patients, and no significant impact of distribution of leukocytes in thrombus on the prognosis of endovascular therapy in AIS patients has been found so far.

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