入院时白细胞计数与脑梗死预后关系的研究

发布时间：2018-01-20 04:20

  本文关键词： 脑梗死 白细胞计数 预后　出处：《河北联合大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的研究急性脑梗死患者入院时白细胞计数与近期预后的关系。 方法连续收集2009年8月~2013年5月发病48h内入住河北联合大学附属医院神经内科二病区的首发急性脑梗死患者452例，采用统一设计的病例调查表，收集所有患者的人口统计学资料、病史资料、入院24小时内实验室检查资料及白细胞计数，对所有患者进行常规治疗，并在发病14天、3个月时进行随访，收集预后情况（死亡、残疾、复发）、神经功能评价（NIHSS评分）和生活自理程度（mRS评分）的资料。研究结局定义为近期预后不良，包括死亡或残疾（mRS≥3）。所有资料采用SPSS19.0软件进行统计学分析，均值比较采用t检验或秩和检验，率的比较采用χ2检验，并运用非条件Logistic回归模型分析急性脑梗死患者入院时白细胞计数与近期预后不良危险性的关系，计算相对危险度和95%可信区间。 结果1本研究收集住院病例452例，完成14天、3个月的随访病例资料分别为452例、447例，死亡发生率分别为1.33%、4.03%；发病3个月内的复发发生率为5.15%。2将研究对象按入院时WBC计数水平分为WBC正常组和WBC升高组，WBC升高组有更多的患者有冠心病史，入院时NIHSS评分、血糖、血脂、血小板计数水平均高于WBC正常组（P0.001），有统计学显著性差异。3WBC升高组的患者在发病14天、3月时的预后不良发生率均显著高于WBC正常组（P0.001），有统计学意义。4WBC升高组患者的在发病后14天、3个月内的死亡发生率均高于WBC正常组，有统计学意义，发病3个月时WBC升高组患者的复发发生率高于WBC正常组，但无明显统计学显著性差异。5将所有研究对象根据四分位数间距将入院时白细胞计数水平分为（WBC5.23×109/L，5.23≤WBC6.20×109/L，6.20≤WBC7.60×109/L和WBC≥7.60×109/L）4组，单因素结果显示急性脑梗死患者发病14天、3个月的预后不良发生率均随入院时静脉白细胞水平的的升高而增高，存在着剂量反应关系。6经多因素模型分析，调整了一些重要的协变量之后，可见与第1组WBC5.23×109/L为参比，WBC≥7.60×109/L组，在急性脑梗死患者发病14天、3个月内发生预后不良的危险比分别为：2.44（1.21，4.92）、2.85（1.43，5.69），有统计学意义。 结论1急性脑梗死患者超早期白细胞计数水平升高可增加发病14天、3个月内预后不良的危险性。2超早期白细胞计数水平升高是急性脑梗死患者病情变化的一个预测指标。
[Abstract]:Objective to study the relationship between leukocyte count and short-term prognosis in patients with acute cerebral infarction. Methods A total of 452 patients with acute cerebral infarction were collected from August 2009 to May 2013 in Department of Neurology, Department of Neurology, affiliated Hospital of Hebei Union University. All patients were routinely treated with the unified design of the case questionnaire, the data of demographics, medical history, laboratory examination and white blood cell count within 24 hours of admission. The patients were followed up for 14 days and 3 months to collect the prognosis (death, disability, recurrence). Data of neurological function evaluation (NIHSS) and self-care degree of life (MRS). The outcome of the study was defined as poor prognosis in the near future. All data were statistically analyzed by SPSS19.0 software. T test or rank sum test were used to compare the mean value and 蠂 2 test was used to compare the rate. Non-conditional Logistic regression model was used to analyze the relationship between leukocyte count and the risk of short-term adverse prognosis in patients with acute cerebral infarction. The relative risk and 95% confidence interval were calculated. Results (1) 452 inpatients were collected and 447 cases were followed up for 14 days and 3 months, respectively. The death rate was 1.33 and 4.03respectively. The incidence of recurrence within 3 months was 5.15.2. According to the WBC count at admission, the subjects were divided into normal WBC group and elevated WBC group. More patients had a history of coronary heart disease. The NIHSS score, blood glucose, blood lipid and platelet count were significantly higher than those in the normal WBC group (P 0.001). The incidence of poor prognosis in March was significantly higher than that in normal WBC group (P 0.001). The incidence of death within 3 months was higher than that of the normal WBC group, with statistical significance. The recurrence rate of the patients with elevated WBC at 3 months was higher than that of the normal WBC group. However, there was no significant difference between the two groups. 5. All the subjects were divided into WBC 5.23 脳 10 9 / L according to the quartile spacing. 5.23 鈮，

本文编号：1446821