本文關(guān)鍵詞： 腦梗死 白細(xì)胞計(jì)數(shù) 預(yù)后　出處：《河北聯(lián)合大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的研究急性腦梗死患者入院時(shí)白細(xì)胞計(jì)數(shù)與近期預(yù)后的關(guān)系。 方法連續(xù)收集2009年8月~2013年5月發(fā)病48h內(nèi)入住河北聯(lián)合大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科二病區(qū)的首發(fā)急性腦梗死患者452例，采用統(tǒng)一設(shè)計(jì)的病例調(diào)查表，收集所有患者的人口統(tǒng)計(jì)學(xué)資料、病史資料、入院24小時(shí)內(nèi)實(shí)驗(yàn)室檢查資料及白細(xì)胞計(jì)數(shù)，對(duì)所有患者進(jìn)行常規(guī)治療，并在發(fā)病14天、3個(gè)月時(shí)進(jìn)行隨訪，收集預(yù)后情況（死亡、殘疾、復(fù)發(fā)）、神經(jīng)功能評(píng)價(jià)（NIHSS評(píng)分）和生活自理程度（mRS評(píng)分）的資料。研究結(jié)局定義為近期預(yù)后不良，包括死亡或殘疾（mRS≥3）。所有資料采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，均值比較采用t檢驗(yàn)或秩和檢驗(yàn)，率的比較采用χ2檢驗(yàn)，并運(yùn)用非條件Logistic回歸模型分析急性腦梗死患者入院時(shí)白細(xì)胞計(jì)數(shù)與近期預(yù)后不良危險(xiǎn)性的關(guān)系，計(jì)算相對(duì)危險(xiǎn)度和95%可信區(qū)間。 結(jié)果1本研究收集住院病例452例，完成14天、3個(gè)月的隨訪病例資料分別為452例、447例，死亡發(fā)生率分別為1.33%、4.03%；發(fā)病3個(gè)月內(nèi)的復(fù)發(fā)發(fā)生率為5.15%。2將研究對(duì)象按入院時(shí)WBC計(jì)數(shù)水平分為WBC正常組和WBC升高組，WBC升高組有更多的患者有冠心病史，入院時(shí)NIHSS評(píng)分、血糖、血脂、血小板計(jì)數(shù)水平均高于WBC正常組（P0.001），有統(tǒng)計(jì)學(xué)顯著性差異。3WBC升高組的患者在發(fā)病14天、3月時(shí)的預(yù)后不良發(fā)生率均顯著高于WBC正常組（P0.001），有統(tǒng)計(jì)學(xué)意義。4WBC升高組患者的在發(fā)病后14天、3個(gè)月內(nèi)的死亡發(fā)生率均高于WBC正常組，有統(tǒng)計(jì)學(xué)意義，發(fā)病3個(gè)月時(shí)WBC升高組患者的復(fù)發(fā)發(fā)生率高于WBC正常組，但無(wú)明顯統(tǒng)計(jì)學(xué)顯著性差異。5將所有研究對(duì)象根據(jù)四分位數(shù)間距將入院時(shí)白細(xì)胞計(jì)數(shù)水平分為（WBC5.23×109/L，5.23≤WBC6.20×109/L，6.20≤WBC7.60×109/L和WBC≥7.60×109/L）4組，單因素結(jié)果顯示急性腦梗死患者發(fā)病14天、3個(gè)月的預(yù)后不良發(fā)生率均隨入院時(shí)靜脈白細(xì)胞水平的的升高而增高，存在著劑量反應(yīng)關(guān)系。6經(jīng)多因素模型分析，調(diào)整了一些重要的協(xié)變量之后，可見(jiàn)與第1組WBC5.23×109/L為參比，WBC≥7.60×109/L組，在急性腦梗死患者發(fā)病14天、3個(gè)月內(nèi)發(fā)生預(yù)后不良的危險(xiǎn)比分別為：2.44（1.21，4.92）、2.85（1.43，5.69），有統(tǒng)計(jì)學(xué)意義。 結(jié)論1急性腦梗死患者超早期白細(xì)胞計(jì)數(shù)水平升高可增加發(fā)病14天、3個(gè)月內(nèi)預(yù)后不良的危險(xiǎn)性。2超早期白細(xì)胞計(jì)數(shù)水平升高是急性腦梗死患者病情變化的一個(gè)預(yù)測(cè)指標(biāo)。
[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，

本文編號(hào)：1446821