| Objective The components of peripheral immune cells that infiltrated into ischemic penumbra are involved in the pathophysiological process of acute cerebral infarction.Additionally,changes of peripheral cellular immune system may also link to the occurrence of infection complications after acute cerebral infarction.Regulation for changes in peripheral cellular immune system may reprsent a potential therapy target for cerebral infarction.Other studies have shown that metformin and sulfonylurea medications may has a significant impact on the peripheral immune system in patients with some diseases.This study was designed to evaluate the effects of metformin or sulfonylurea medications on the characteristics of peripheral blood leukocyte subsets,and the prognosis of patients with acute cerebral infarction,so as to further find the possible impact factors for peripheral cellular immune system after cerebral infarction.Moreover,this study will also help us to find valuable therapeutic targets or methods for cerebral infarction.MethodsIn this study,204 in-patients with acute cerebral infarction who met the inclusion and exclusion criteria in the Fifth Affiliated Hospital of Zhengzhou Univerity from January 2015 to December 2019 were selected,and all patients were divided into the following four groups: 45 patients in the metformin group who were treated with metformin for at least 2 weeks before stroke onset;37 patients in the sulfonylurea group who received sulfonylurea hypoglycemic agents for at least 2 weeks before stroke onset;47 patients in the dual-drug group who received both drugs for at least 2weeks before stroke onset;75 patients who did received any hypoglycemic drugs;42 healthy subjects in healthy control group(All patients in the first 3 groups continued to use the above drugs to regulate blood glucose levels during the treatment period after stroke onset).The characteristics of peripheral blood leukocyte subsets on day 1 after stroke onset,NIHSS score on admission,and the m RS at 3 months after stroke onset were recored and collected in this study.All patients with acute cerebral infarction were also subdivided into anterior circulation infarction and posterior circulation infarction group according to infarct location.We will evaluate the effects of metformin and sulfonylurea medications on the characteristics of peripheral blood leukocyte subsets,and the prognosis of patients with acute cerebral infarction.Results1.Patients in case control group(n=75)had higher neutrophil count and monocyte count in peripheral blood than that in healthy controls(n=42).Lymphocyte count and lymphocyte to monocyte ratio(LMR)declined,while neutrophil to lymphocyte ratio(NLR)increased in peripheral blood of patients in case control group when compared with healthy controls(all P<0.05).2.When compared with case controls(n=75),the neutrophil count and NLR decreased significantly,while LMR increased significantly in the metformin group(n=45,all P<0.05);the eosinophil count and LMR increased,while NLR decreased dramatically in the sulfonylurea group(n=37,all P<0.05);the neutrophil count and LMR decreased significantly,while LMR increased significantly in the double-drug group(all n=47,P<0.05).3.In the posterior circulation infarction group,the NLR in the peripheral blood of metformin group(n=16)was obviously lower than that of matched control group(n=31).In the anterior circulation infarct group,the NLR in the peripheral blood of the sulfonylurea group(n=19)was significantly lower than that of the matched control group(n=44).While in the posterior circulation infarct group the sulfonylurea group(n=18)had significantly higher LMR in peripheral blood compared with the matched controls(n=31).In the sub-group of posterior circulation infarction,the neutrophil count and NLR in peripheral blood of the dual-drug group(n=21)was significantly reduced when compared with that in the matched control group(n=31).4.Patients in the metformin group and the case control group were divided into a favourable prognosis group(m RS≦2)and an unfavourable prognosis group(m RS≧3)according to m RS scores.Patients(n=29)with unfavourable prognosis tended to has higher NIHSS scores,larger infarct size compared with patients(n=91)with favourable prognosis.Patients with unfavourable prognosis were more likely to be combined with the history of coronary heart disease,hypertension and previous stroke,.In addition,the NLR decreased significantly in peripheral blood of patients with good prognosis when compared with that in patients with poor prognosis.Higher NIHSS scores,larger infarct size,and previous history of coronary heart disease were associated with a 90-day unfavourable prognosis of our patients.While metformin administration before stroke had no effects on the 90-day prognosis of patients with acute cerebral infarction.Patients in the sulfonylurea group and case control group were divided into a favourable prognosis group(m RS≦2)and a unfavourable prognosis group(m RS≧3)according to MRS scores.Compared with patientswith favourable prognosis(n=84),patients with unfavourable prognosis(n=28)had higher NIHSS score and larger infarct size,and was more likely to be combined with history of coronary heart disease,hypertension and previous stroke history.Compared with patients with unfavourable prognosis,the NLR and NMR in peripheral blood of patients with favourable prognosis decreased.Higher NIHSS scores and larger infarct size were associated with a poor 90-day prognosis of patients.Sulfonylurea use before stroke had no effects on the 90-day prognosis of patients with acute cerebral infarction.According to the m RS scores,the patients in the double-drug group and the case control group were divided into a favourable prognosis group(m RS≦2)and a unfavourable prognosis group(m RS≧3).Compared with patientswith favourable prognosis(n=92),patientswith unfavourable prognosis(n=30)had higher NIHSS score and larger infarct size,and was more likely to be combined with risk factors such as history of hypertension,coronary heart disease,and previous stroke history.NMR in peripheral blood was decreased in patients with favourable prognosis as compared with that in patients with unfavourable prognosis.A higher NIHSS score and larger infarct size and a previous history of coronary heart disease were associated with a 90-day poor prognosis of our patients.The combination of diaformin metformin and sulfonylurea use before stroke had no effects on the 90-day prognosis of patients with acute cerebral infarction.Conclusion1.Acute cerebral infarction induced significant changes in peripheral blood leukocyte subsets,such as increased neutrophil count and decreased lymphocyte count.2.The use of metformin,sulfonylurea or drug combination before the onset of acute cerebral infarction,can partially reverse the changes of peripheral cellular immune system.3.Higher NIHSS score,larger infarction volume and previous history of coronary heart disease were independently correlated with the adverse functional outcome of 90 days after cerebral infarction.However,the use of metformin or sulfonylureas before stroke had no effect on the functional prognosis of patients with cerebral infarction at 90 days. |
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