Correlation Of Peripheral Blood Inflammatory Cells With Collateral Circulation In Patients With Acute Ischemic Stroke

Objective:To investigate the correlation between peripheral blood inflammatory cells and collateral circulation in patients with acute ischemic stroke(AIS).Methods:46 patients with unilateral internal carotid artery or middle cerebral artery stenosis or occlusion of AIS who were admitted to the neurology Department or emergency Department of the Hospital from April 2020 to January 2022 were included in a retrospective study.Inclusion criteria were based on the AIS diagnostic criteria in the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018:(1)patients with first onset or history of stroke without sequelae;(2)age≥18 years;(3)patients with non-intravenous thrombolysis and endovascular treatment with onset≤72 hours;(4)patients with focal neurological deficits at the time of presentation;(5)patients with unilateral internal carotid artery or middle cerebral artery infarction on imaging;(6)patients with complete clinical data and imaging data.Exclusion criteria:(1)patients with severe cardiac,hepatic and renal insufficiency;(2)patients with malignant tumors,intracranial hemorrhage or other cerebral vascular diseases(such as Moyamoya disease);(3)patients with a history of severe food,drug and contrast allergy;(4)patients with transient ischemic attack;(5)patients with lung or other site infections;(6)patients with chronic infectious diseases or autoimmune system diseases.One-stop head CT scan was performed after admission,and 4D-CTA image was obtained through CT perfusion scan original image reconstruction.The lateral branches of the pia meningeal of the patients were evaluated by improved American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)collateral circulation scoring method,and the patients were divided into two groups(good and bad collateral circulation).Meanwhile,the clinical history,fasting blood routine examination and homocysteine test results of the patients after admission were collected.The Kappa test was used to analyze the inter-rater agreement on the graded assessment of collateral circulation.The t test,Mann-Whitney U test and?~2test were used to compare the data between the two groups.Analyzing the correlation between collateral circulation score and neutrophil count,lymphocyte count,eosinophil count and neutrophil to lymphocyte ratio(NLR)with Spearman rank correlation.The receiver operating characteristic curve(ROC)was further used to explore the predictive value of neutrophil count,lymphocyte count,eosinophil count and NLR for poor collateral circulation.Results:A total of 46 patients were included in this study for analysis,including 28with good collateral circulation and 18 with poor collateral circulation.Inter-rater agreement analysis of the graded assessment of the collateral circulation had a Kappa value of 0.94 and a Kappa>0.75,with good agreement.There were no significant differences in age,gender,hypertension,hyperglycemia,dyslipidemia,history of heart disease,smoking history and drinking history between the two groups(P≥0.05).There were no statistically significant differences in homocysteine,white blood cell count,red blood cell count,monocyte count and basophil count(P≥0.05),while there were statistically significant differences in neutrophil count,lymphocyte count,eosinophil count and NLR(P<0.05).Lymphocyte count(r=0.511,P<0.001)and eosinophil count(r=0.415,P<0.05)were positively correlated with collateral circulation score.The neutrophil count(r=-0.351,P<0.05)and NLR(r=-0.515,P<0.001)were negatively correlated with collateral circulation score.The areas under the ROC curve for neutrophil count,lymphocyte count,eosinophil count and NLR diagnosis of poor collateral circulation were 0.728,0.794,0.778 and 0.817,respectively.Conclusion:Neutrophil count,lymphocyte count,eosinophil count and NLR are related to collateral circulation in patients with ischemic stroke in acute stage,and low lymphocyte count,low eosinophil count,high neutrophil count and high NLR predict poor collateral circulation.