淋巴细胞计数对脑出血患者外科治疗后颅内压影响的研究
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摘要
目的探究淋巴细胞计数对脑出血患者外科治疗后ICP的影响。方法选取2016年7月—2018年4月在该院接受外科治疗的脑出血患者97例,统计97例患者外科治疗后ICP,按ICP是否大于20 mmHg分为对照组和ICP升高组,对照组56例,ICP升高组41例。分别收集两组入院24 h的外周静脉血,统计中性粒细胞、单核细胞及淋巴细胞计数,检测NK细胞水平、B淋巴细胞特异性表达抗原CD19和T淋巴细胞CD4、CD8亚群的含量。患者发病90 d后评价患者预后情况。结果两组的中性粒细胞、单核细胞计数差异无统计学意义(P>0.05),ICP升高组的淋巴细胞计数(2.32±0.49)×109/L高于对照组(1.47±0.54)×109/L(t=-7.958,P<0.001);ICP升高组的NK细胞含量(0.21±0.07)×109/L和CD19含量(0.20±0.08)×109/L显著高于对照组(0.14±0.08)×109/L和(0.12±0.06)×109/L (t=-4.484,P<0.001;t=-5.389,P<0.001),CD4含量(0.29±0.12)×109/L显著低于对照组(0.41±0.13)×109/L (t=4.638,P=0.012),CD8含量差异无统计学意义(P>0.05);ICP升高组的预后良好例数(56.10%)少于对照组(91.07%)(χ~2=8.831,P=0.007)。结论淋巴细胞计数与脑出血患者外科治疗后ICP呈正相关,其中NK细胞和B淋巴细胞计数与ICP呈正相关,T淋巴细胞CD4亚群与ICP水平呈负相关,淋巴细胞及其亚群计数可作为脑出血患者外科治疗后颅内压预测指标,有助于改善患者预后。
Objective To investigate the effect of lymphocyte count on ICP after surgical treatment of patients with cerebral hemorrhage.Methods A total of 97 patients with cerebral hemorrhage who underwent surgical treatment in our hospital from July 2016 to April2018 were enrolled. The ICP of 97 patients after surgical treatment were divided into control group and ICP elevated group according to whether ICP was greater than 20 mmHg. 56 cases in the control group, 41 cases of ICP elevated group. Peripheral venous blood was collected from the two groups for 24 hours. The neutrophil, monocyte and lymphocyte counts were counted. The levels of NK cells, B lymphocyte-specific antigen CD19 and T lymphocyte CD4 and CD8 subpopulations were detected. The patient's prognosis was evaluated 90 days after the onset of the disease. Results There were no significant differences in neutrophil and monocyte counts between the two groups(P>0.05). The lymphocyte counts in the ICP-increased group(2.32±0.49)×109/L were higher than those in the control group(1.47±0.54)×109/L(t=-7.958, P<0.001); NK cell content(0.21±0.07)×109/L and CD19 content(0.20±0.08)×109/L in the ICP-increased group were significantly higher than those in the control group(0.14±0.08)×109/L and(0.12±0.06)×109/L(t=-4.484, P<0.001; t=-5.389, P<0.001), CD4 content(0.29±0.12)×109/L was significantly lower than that of the control group(0.41±0.13)×109/L(t=4.638, P=0.012), and there was no significant difference in CD8 content(P>0.05); the number of good prognosis in the ICP-increased group(56.10%) was less than that in the control group(91.07%)(χ~2=8.831, P=0.007). Conclusion Lymphocyte count is positively correlated with ICP after surgical treatment in patients with cerebral hemorrhage. The counts of NK cells and B lymphocytes are positively correlated with ICP. The CD4 subpopulation of T lymphocytes is negatively correlated with ICP level. The lymphocyte and its subpopulation count can be used as The predictive value of intracranial pressure after surgical treatment of patients with cerebral hemorrhage helps to improve the prognosis of patients.
Objective To investigate the effect of lymphocyte count on ICP after surgical treatment of patients with cerebral hemorrhage.Methods A total of 97 patients with cerebral hemorrhage who underwent surgical treatment in our hospital from July 2016 to April2018 were enrolled. The ICP of 97 patients after surgical treatment were divided into control group and ICP elevated group according to whether ICP was greater than 20 mmHg. 56 cases in the control group, 41 cases of ICP elevated group. Peripheral venous blood was collected from the two groups for 24 hours. The neutrophil, monocyte and lymphocyte counts were counted. The levels of NK cells, B lymphocyte-specific antigen CD19 and T lymphocyte CD4 and CD8 subpopulations were detected. The patient's prognosis was evaluated 90 days after the onset of the disease. Results There were no significant differences in neutrophil and monocyte counts between the two groups(P>0.05). The lymphocyte counts in the ICP-increased group(2.32±0.49)×109/L were higher than those in the control group(1.47±0.54)×109/L(t=-7.958, P<0.001); NK cell content(0.21±0.07)×109/L and CD19 content(0.20±0.08)×109/L in the ICP-increased group were significantly higher than those in the control group(0.14±0.08)×109/L and(0.12±0.06)×109/L(t=-4.484, P<0.001; t=-5.389, P<0.001), CD4 content(0.29±0.12)×109/L was significantly lower than that of the control group(0.41±0.13)×109/L(t=4.638, P=0.012), and there was no significant difference in CD8 content(P>0.05); the number of good prognosis in the ICP-increased group(56.10%) was less than that in the control group(91.07%)(χ~2=8.831, P=0.007). Conclusion Lymphocyte count is positively correlated with ICP after surgical treatment in patients with cerebral hemorrhage. The counts of NK cells and B lymphocytes are positively correlated with ICP. The CD4 subpopulation of T lymphocytes is negatively correlated with ICP level. The lymphocyte and its subpopulation count can be used as The predictive value of intracranial pressure after surgical treatment of patients with cerebral hemorrhage helps to improve the prognosis of patients.
引文
[1]王希佳,李星,周子英,等.银杏达莫联合醒脑静治疗脑出血患者疗效及对外周血S100 B、神经肽Y水平的影响[J].世界中医药,2017,12(12):2916-2918.
[2]Telemetric Intracranial Pressure Monitoring in Blast-Indu ced Traumatic Brain Injury[J].IEEE Transactions on Biomedical Engineering,2014,61(3):841-847.
[3]Reisner A,Chen X,Kumar K,et al.Prehospital heart rate and blood pressure increase the positive predictive value of the glasgow coma scale for high-mortality traumatic brain injury[J].Journal of neurotrauma,2014,31(10):906-913.
[4]高志刚,宋慧芳,陈翠娟,等.不同脑灌注压水平颅内压水平对颅内压升高患者预后的影响[J].山西医药杂志,2016,45(18):2177-2178.
[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[6]ChengBForkert ND,Zavaglia M,et al.Influence of stroke infarct location on functional outcome measured by the modified rankin scale[J].Stroke:A Journal of Cerebral Circulation,2014,45(6):1695-1702.
[7]韦拳堂,钟志伟,张子衡,等.颅内压监测在高血压脑出血微创治疗中的应用[J].实用医学杂志,2016,32(7):1136-1139.
[8]高国一,江基尧.颅内压监测在颅脑创伤临床管理中的应用[J].天津医药,2017,45(8):803-805.
[9]宋大桥,曹校校,俞小芬,等.中西医结合治疗急性脑出血的临床研究---中医中风病诊疗规范研究之二[J].世界中医药,2015,12(9):1358-1362.
[10]赵海臣,杨维明,陈萌,等.醒脑静注射液并联血液净化治疗脑出血后系统性炎症反应综合征的临床观察[J].世界中西医结合杂志,2016,11(10):1416-1417,1428.
[11]张芸,樊新颖,张顺源,等.中性粒细胞与淋巴细胞比值预测急性脑出血患者转归[J].国际脑血管病杂志,2017,25(7):638-643.
[2]Telemetric Intracranial Pressure Monitoring in Blast-Indu ced Traumatic Brain Injury[J].IEEE Transactions on Biomedical Engineering,2014,61(3):841-847.
[3]Reisner A,Chen X,Kumar K,et al.Prehospital heart rate and blood pressure increase the positive predictive value of the glasgow coma scale for high-mortality traumatic brain injury[J].Journal of neurotrauma,2014,31(10):906-913.
[4]高志刚,宋慧芳,陈翠娟,等.不同脑灌注压水平颅内压水平对颅内压升高患者预后的影响[J].山西医药杂志,2016,45(18):2177-2178.
[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[6]ChengBForkert ND,Zavaglia M,et al.Influence of stroke infarct location on functional outcome measured by the modified rankin scale[J].Stroke:A Journal of Cerebral Circulation,2014,45(6):1695-1702.
[7]韦拳堂,钟志伟,张子衡,等.颅内压监测在高血压脑出血微创治疗中的应用[J].实用医学杂志,2016,32(7):1136-1139.
[8]高国一,江基尧.颅内压监测在颅脑创伤临床管理中的应用[J].天津医药,2017,45(8):803-805.
[9]宋大桥,曹校校,俞小芬,等.中西医结合治疗急性脑出血的临床研究---中医中风病诊疗规范研究之二[J].世界中医药,2015,12(9):1358-1362.
[10]赵海臣,杨维明,陈萌,等.醒脑静注射液并联血液净化治疗脑出血后系统性炎症反应综合征的临床观察[J].世界中西医结合杂志,2016,11(10):1416-1417,1428.
[11]张芸,樊新颖,张顺源,等.中性粒细胞与淋巴细胞比值预测急性脑出血患者转归[J].国际脑血管病杂志,2017,25(7):638-643.