| Background:Chronic subdural hematoma is commonly seen in neurosurgery.Its main feature is that the substances containing blood components accumulate abnormally in the subdural space and are slowly organized,and the volume increases continuously.Because of the long course of chronic subdural hematoma,the human body has a certain compensatory capacity for the slow increase of the volume of hematoma.When patients have symptoms of increased intracranial pressure such as headache,vomiting and changes in local nerve function,the volume of hematoma is huge and the midline shift is obvious.Although the operation is less difficult and the effect is obvious,most of the patients with chronic subdural hematoma are older than 60years old,with poor physical basic conditions,often accompanied by various chronic diseases.Surgical removal of hematoma still has a great risk,and some patients have a recurrence of chronic subdural hematoma or subdural effusion for a period of time after operation.Therefore,there is still a great controversy about whether surgical treatment is the first choice.It is very important to study the pathogenesis of chronic subdural hematoma in depth.Although there are many hypotheses about the formation mechanism of chronic subdural hematoma,the exact pathogenesis of chronic subdural hematoma is still controversial.The study of the pathogenesis of chronic subdural hematoma is helpful for the treatment of this disease and the effective prevention of recurrence.At present,the mainstream theory is penetration theory.The tear of bridging vein caused by mild trauma,the slow exudation of venous blood,and the accumulation of hematoma cavity,because of the slow speed of bleeding,there are often no clinical symptoms in the early stage.When the hematoma cavity increases to a certain extent,intracranial pressure decompensates,which leads to headache,vomiting and local neurological symptoms.However,this theory is not yet able.To fully explain the occurrence of this disease,recent studies have found some inflammatory factors in the hematoma cavity and parietal layer of chronic subdural hematoma.This study suggests that systemic immune inflammation may be involved in the formation of chronic subdural hematoma.Following this research result,some scholars now try to treat chronic subdural hematoma with drugs,such as atorvastatin,dexamethasone and other drugs,which have achieved certain results in some cases.Objective:A retrospective analysis was made on 266 cases of chronic subdural hematoma admitted to the outpatient and emergency department of the First Hospital of Chinese Medical University from January 2011 to December 2018,with an average age of(63.55±9.19)years.Among them,200 were male patients and 66 were female patients,152 had head trauma history(1-7 months),114 had no head trauma history,205 had unilateral subdural hematoma,61 had bilateral subdural hematoma,262 had primary subdural hematoma,and 4 had recurrence of subdural hematoma.As the control group,the average age was(56.68±14.78)years old,including 81 males and 69 females.Peripheral venous blood was collected for routine blood test in case group and control group.The total number of white blood cells,neutrophils,lymphocyte,monocytes and platelets in each case and control group were collected and sorted out.The total number of white blood cells,NLR,PLR and LMR in each case group and control group were calculated and sorted out.IBM SPSS22.0 statistical software was used for data processing.The measurement data are expressed as(x±s).To evaluate the changes of peripheral blood leukocyte count?NLR?PLR and LMR between patients with chronic subdural hematoma and healthy control group,traumatic chronic subdural hematoma and non-traumatic chronic subdural hematoma,non-traumatic chronic subdural hematoma in male patients and female patients.Independent sample T test was used for statistical analysis.Results:The results showed that the average number of white blood cells in chronic subdural hematoma group was(6.92±1.94)×10~9/L,in healthy control group was(6.26±1.39)×10~9/L,(t=3.678,p=0.0003),the average number of NLR in chronic subdural hematoma group was(3.4±2.69),and that in healthy control group was(1.82±0.86),(t=6.985,P<0.0001);the mean value of PLR in chronic subdural hematoma group was(147.2±80.3),in healthy control group was(127.8±51.04),(t=2.670,p=0.0079),and LMR in chronic subdural hematoma group was(3.95±2.04),in healthy control group was(5.12±1.78),(t=5.878,p<0.0001).The average leucocyte count in traumatic chronic subdural hematoma group was(6.95±1.71)and that in non-traumatic chronic subdural hematoma group was(6.87±2.22),(t=0.337,p=0.736);The average value of NLR in traumatic chronic subdural hematoma group was(3.06±1.96),while that in non-traumatic chronic subdural hematoma group was(3.86±3.39),(t=2.419,p=0.0162);PLR in traumatic chronic subdural hematoma group was(136.3±59.73);and that in non-traumatic chronic subdural hematoma group was(161.9±99.88),(t=2.606,p=0.0097);The mean value of LMR in traumatic chronic subdural hematoma group was(4.06±2.03),and that in non-traumatic chronic subdural hematoma group was(3.8±2.04),(t=1.048,P=0.296).The average number of white blood cells in non-traumatic chronic subdural hematoma group was(6.8±2.15)in males and(7.01±2.3)in females(t=0.5593,P=0.577);the average number of NLR in non-traumatic chronic subdural hematoma group was(3.82±3.62)in males and(3.93±2.8)in females(t=0.1591,P=0.8738);The mean PLR of non-traumatic chronic subdural hematoma in male group was(152.7±96.79),and that of female group was(184.5±105.2),(t=1.551,p=0.1237);that of non-traumatic chronic subdural hematoma in male group was(3.72±2.12),and that of female group was(3.99±1.87),(t=0.6296,p=0.5302).Conclusion:The results showed that the white blood cells in peripheral blood of patients with chronic subdural hematoma were significantly different from those of healthy control group.The NLR and PLR in peripheral blood of patients with chronic subdural hematoma were significantly higher than those of healthy control group,while the LMR was significantly lower than that of healthy control group.The NLR and PLR in peripheral blood of patients with traumatic chronic subdural hematoma were significantly smaller than those of non-traumatic chronic subdural hematoma group,while traumatic subdural hematoma was significantly lower than that of non-traumatic chronic sub There was no significant difference in peripheral white blood cells and LMR between group A and group B.There was no significant difference in peripheral white blood cells,NLR,PLR,LMR between male and female patients with non-traumatic chronic subdural hematoma.This study shows that chronic subdural hematoma patients have systemic inflammatory abnormalities;inflammatory immune abnormalities play a more important role in non-invasive chronic subdural hematoma than traumatic chronic subdural hematoma;inflammatory immune abnormalities have no difference in male patients with non-traumatic chronic subdural hematoma and female patients with non-traumatic chronic subdural hematoma.Anti-inflammatory drugs have important clinical significance in treating chronic subdural hematoma. |
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