Leukocyte Count and Intracerebral Hemorrhage Expansion.
Leukocyte Count and Intracerebral Hemorrhage Expansion.
复制标题
白细胞计数与脑出血扩大
DOI：
10.1161/strokeaha.116.013176
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发表时间：
2016-06
期刊：
影响因子：
8.3
通讯作者：
Rosand J
中科院分区：
文献类型：
--
作者：
Morotti A;Phuah CL;Anderson CD;Jessel MJ;Schwab K;Ayres AM;Pezzini A;Padovani A;Gurol ME;Viswanathan A;Greenberg SM;Goldstein JN;Rosand J
急性白细胞增多是脑出血（ICH）的一种公认反应。白细胞由于其与血小板和凝血因子的相互作用，可能反过来在止血中发挥作用。我们调查了入院时白细胞增多是否与急性ICH后出血减少有关。前瞻性收集了1994年至2015年的原发性ICH连续患者，并进行了回顾性分析。我们纳入了随访CT扫描可用的受试者，并在发病后48小时内进行了自动完整的白色血细胞（WBC）计数。使用半自动软件计算基线和随访血肿体积，血肿扩大定义为体积增加> 30%或6 mL。采用多因素Logistic回归分析WBC计数与脑出血扩大之间的关系。1302例受试者符合合格性标准（中位年龄75岁，55.8%为男性），其中207例（15.9%）发生血肿扩大。入院时较高的白细胞计数与血肿扩大风险降低相关（1000个细胞增加的比值比[OR] 0.91，95%置信区间[CI] 0.86-0.96，p=0.001）。血肿扩大的风险与中性粒细胞计数呈负相关（OR 0.90，95% CI 0.85-0.96，p=0.001），与单核细胞计数直接相关（OR 2.71，95% CI 1.08-6.83，p=0.034）。淋巴细胞计数与ICH扩大之间无相关性（OR 0.96，95% CI 0.79-1.17，p=0.718）。较高的入院白细胞计数与较低的血肿扩大风险相关。这突出了急性ICH后炎症反应在调节凝血级联反应中的潜在作用。
Acute leukocytosis is a well-established response to intracerebral hemorrhage (ICH). Leukocytes, because of their interaction with platelets and coagulation factors, may in turn play a role in hemostasis. We investigated whether admission leukocytosis was associated with reduced bleeding following acute ICH. Consecutive patients with primary ICH were prospectively collected from 1994 to 2015 and retrospectively analyzed. We included subjects with a follow-up CT scan available and automated complete white blood cell (WBC) count performed within 48 h from onset. Baseline and follow-up hematoma volumes were calculated with semi-automated software and hematoma expansion was defined as volume increase > 30% or 6 mL. The association between WBC count and ICH expansion was investigated with multivariate logistic regression. 1302 subjects met eligibility criteria (median age 75 years, 55.8 % males), of whom 207 (15.9 %) experienced hematoma expansion. Higher leukocyte count on admission was associated with reduced risk of hematoma expansion (Odds Ratio for 1000 cells increase [OR] 0.91, 95 % Confidence Interval [CI] 0.86–0.96, p=0.001). The risk of hematoma expansion was inversely associated with neutrophil count (OR 0.90, 95 % CI 0.85–0.96, p=0.001) and directly associated with monocyte count (OR 2.71, 95 % CI 1.08–6.83, p=0.034). There was no association between lymphocyte count and ICH expansion (OR 0.96, 95 % CI 0.79–1.17, p=0.718). Higher admission WBC count is associated with lower risk of hematoma expansion. This highlights a potential role of the inflammatory response in modulating the coagulation cascade following acute ICH.