血小板聚集率对急性脑梗死诊断价值及发病关系的探讨  

Diagnostic Value of Platelet Aggregation Rate and Its Relationship with Acute Cerebral Infarction

作　　者：石冬敏[1] 沈明强[1] 张志平[1] 

机构地区：[1]南京医科大学附属苏州医院、苏州市立医院,江苏苏州215002

出　　处：《中国血液流变学杂志》2012年第3期511-514,524,共5页Chinese Journal of Hemorheology

基　　金：苏州市科教兴卫青年基金资助项目（2010SWKQ-1023）

摘　　要：目的观察急性脑梗死患者血小板最大聚集率（MAR）水平，分析其诊断价值和发病的关系。方法急性脑梗死组120例，入院次日晨空腹采血，透射比浊法测定花生四烯酸诱导MAR（MARAA）和二磷酸腺苷诱导MAR（MARAADP）。结果脑梗死组MARAA62．9％±17．6％、MARADP66．8％±14．2％，健康对照组为56．6％±14．1％、60．1％±13．5％，组间t检验均有统计学意义（P〈0．05）；MARAA与MARADP以及不同性别间MAR水平差异均无统计学意义（P〉0．05）。患者发病年龄与MAR以及MARAA与MARADP均无直线性关联（r≤0．1）。受试者工作特征曲线确定Cut off，MARAA为57％，AUC为0．61，诊断正确率为88％；MARADP分别为60％、0．62、58％。65．4％患者MAR〉Cut off，10％超出正常参考值上限，12．5％低水平。Logistic回归分析：MARAA OR值为3．026，有统计学意义（P=0．017）。MARADP为1．058，无统计学意义（P=0．906）。结论急性脑梗死患者MAR水平上调，无性别差异，与年龄无关。MAR诊断价值低，高水平MARAA是脑梗死发病的独立危险因子。预防和治疗脑卒中，ASA与氯吡格雷应同时给药，但应监测MAR，个体化用药。Objective To observe platelet aggregation rate in patients with acute cerebral infarction （ACI） and analyze the diagnostic value and the relationship with ACI.Methods 120 patients with ACI and 50 normal control subjects were in our study.The venous blood samples were collected on the second day after admission,determining the MARAA and MARADP by transmission turbidimetry.Results MAR was 62.9%±17.6% induced by AA and 66.8%±14.2% induced by ADP in the disease group,and MAR was 56.6%±14.1% induced by AA and 60.1%±13.5% induced by ADP in the control group.There was a statistical significance between the patients group and the control group（P 〈 0.05）.No statistically significant differences were noted between MARAA and MARADP（P 〉 0.05）.There was no linear correlation between MARADP and MARAA or between MAR and age of onset of ACI.The cut off point of MARAA according to ROC curve was 57% and AUC was 0.61 and the accuracy was 88%.The cut off value of MARADP according to ROC curve was 60% and AUC,accuracy were 0.62,58% respectively.The MAR in 65.4% of the patients was higher than the cut off value and 10% than the upper reference limit.Logistic regression analysis showed MARAA（OR=3.026,P=0.017） has statistical significance. MARADP（OR=1.058,P=0.906） has no statistical significance.Conclusion The MAR level increased in the patients with ACI and was not correlated with gender or age.The diagnostic value of MAR is low. High level MARAA is an independent risk factor for ACI.Both Aspirin and Clopidogrel are advised on prevention and treatment for ACI and MAR should be monitored actively.

关 键 词：血小板聚集率 急性脑梗死 花生四烯酸 二磷酸腺苷 

分 类 号：R446.11[医药卫生—诊断学] R743[医药卫生—临床医学]