平均血小板容积对rtPA静脉溶栓治疗的缺血性脑卒中病人预后的预测价值  

The predict value of the mean platelet volume on prognosis of the ischemic stroke patients treated with rtPA intravenous thrombolysis

作　　者：史桂芬 张素琴[2] 许宏洲 SHI Gui-fen;ZHANG Su-qin;XU Hong-zhou(Department of Clinical Laboratory,Suzhou Municiple Hospital,Suzhou Anhui 34000;Department of Plastic and Burn;Department of Emergency,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]安徽省宿州市立医院检验科,234000 [2]蚌埠医学院第一附属医院整形烧伤科,安徽蚌埠233004 [3]蚌埠医学院第一附属医院急诊内科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2018年第11期1501-1504,共4页Journal of Bengbu Medical College

摘　　要：目的:探讨平均血小板容积(MPV)对重组组织型纤溶酶原激活剂(rt PA)静脉溶栓治疗的缺血性脑卒中病人预后的预测价值。方法:采用改良Rankin量表(MRS)评价rt PA溶栓治疗病人预后状况,分为预后良好组和预后不良组,探讨MPV对溶栓治疗的预后的影响。结果:2组病人年龄、房颤发生率、既往服用阿司匹林、收缩压、舒张压、NIHSS评分、INR、血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血小板压积、MPV、血小板分布宽度和CISS分型差异均有统计学意义(P <0. 05～P <0. 01)。logistic回归分析结果显示,年龄、既往服用阿司匹林、基线NIHSS评分、血糖、低密度脂蛋白胆固醇、MPV、血小板分布宽度、心源性卒中型及穿支动脉疾病型均为rt PA溶栓治疗预后的独立影响因素(P <0. 05～P <0. 01)。线性回归分析结果显示,MPV与MRS评分呈负相关关系(r=-0. 435,P <0. 05),MPV诊断rt PA溶栓治疗预后的最佳临界点为10. 12 f L,其灵敏度、特异度、AUC、阴性预测值、阳性预测值以及准确度分别为89. 2%、87. 8%、0. 882、84. 6%、91. 5%、88. 4%。结论:MPV对rt PA溶栓治疗急性缺血性脑卒中有一定的预测价值,为短期溶栓治疗预后的独立危险因素。Objective： To investigate the predict value of the mean platelet volume（ MPV） on prognosis of the ischemic stroke patients treated with recombinant tissue type plasminogen activator（ rt PA） intravenous thrombolysis. Methods： The prognosis of patients treated with rt PA thrombolysis was evaluated using the modified Rankin scale（ MRS）. The patients were divided into the good prognosis group and poor prognosis group,and the influence of MPV on the prognosis of patients treated with rt PA thrombolysis was discussed. Results：The differences of the age,incidence rate of atrial fibrillation,aspirin use history,systolic blood pressure,diastolic blood pressure,NIHSS score,INR,blood glucose,total cholesterol,high-density lipoprotein cholesterol,low density lipoprotein cholesterol,thrombocytocrit,MPV,platelet distribution width and CISS typing between two groups were statistically significant（ P〈0. 05 to P〈0. 01）. Logistic regression analysis showed that the age,previous aspirin use history,baseline NIHSS score,blood glucose,LDL-C,MPV,PDW,cardiogenic stroke and perforating artery disease were the independent influencing factors of the prognosis of rt PA thrombolytic therapy（ P〈0. 05 to P〈0. 01）. Linear regression analysis showed that the MPV was negatively correlated with MRS score（ P〈0. 05）. The best clinic point of MPV in the diagnosis of the prognosis of rt PA thrombolytic therapy was 10. 12 f L,and the sensitivity,specificity,AUC,negative predictive value,positive predictive value and accuracy of MPV were 89. 2%,87. 8%,0. 882,84. 6%,91. 5% and 88. 4%,respectively. Conclusions： MPV has a certain predictive value in rt PA thrombolysis treating acute ischemic stroke,which is an independent risk factor of short-term thrombolysis treatment.

关 键 词：脑缺血 静脉溶栓 重组组织型纤溶酶原激活剂 平均血小板容积 

分 类 号：R743.31[医药卫生—神经病学与精神病学]