重度颅脑损伤患者急性期血小板平均体积与近期预后不良相关性分析  

Correlation between mean platelet volume in acute phase and short-term poor prognosis in patients with severe craniocerebral injury

作　　者：霍龙伟[1] 王国伟[1] 郑虎林[1] 崔政[1] 张轩宇 王亚飞 HUO Longwei;WANG Guowei;ZHENG Hulin(The First Hospital of Yulin City in Shaanxi Province,Yulin 719000)

机构地区：[1]陕西省榆林市第一医院

出　　处：《陕西医学杂志》2020年第1期60-63,共4页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2018ZDXM-SF-040)

摘　　要：目的:探讨重度颅脑损伤患者急性期血小板平均体积(MPV)与近期预后不良的相关性。方法:选取重度颅脑损伤患者152例为研究对象,按照入院时MPV水平分为MPV增高组和非MPV增高组,并按照随访入院后6个月的格拉斯哥预后评分(GOS)分为预后良好组和预后不良组,比较各组一般临床资料的差异。结果:与非MPV增高组比较,MPV增高组入院GOS评分偏低,多发脑挫裂伤比例、颅内血肿量、合并脑疝比例、血浆D-二聚体(D-D)、纤维蛋白原(Fib)、C反应蛋白(CRP)、改良CT图像评分中9~14分的患者比例及平均分值、预后不良比例及GOS平均分值均较高,两组比较差异具有统计学意义P<0.05);与预后良好组比较,预后不良组MPV、D-D、CRP、Fib、改良CT图像评分均较高,两组比较差异具有统计学意义P<0.05)。Pearson相关性分析显示,MPV与颅内血肿量、D-D、CRP、Fib、改良CT图像评分、血小板分布宽度(PDW)呈正相关,与GOS评分、血小板计数(PLT)呈负相关(P<0.05)。多元Logistic回归方程显示MPV是患者预后不良的独立危险因素(OR=1.957,P=0.009);ROC曲线显示MPV预测预后不良的AUC为0.859,敏感性和特异性为83.71%和85.74%,最佳诊断截点为13.20 fl。结论:急性期MPV水平增高可能是重度颅脑损伤预后不良的独立预测因素,临床应当密切监测MPV水平变化,建议将其作为评价患者病情和预后的辅助参考指标之一。Objective:To investigate the correlation between mean platelet volume(MPV) in acute phase and short-term poor prognosis in patients with severe craniocerebral injury. Methods:152 cases of severe craniocerebral injury patients were selected as the research subjects and divided into MPV-increased group and non-MPV-increased group according to the level of MPV at admission. According to GOS at 6 months after admission,they were divided into good prognosis group and poor prognosis group. The differences in general clinical data of each group were compared. Results:Compared with non-MPV-increased group,in MPV-increased group the GOS at admission was lower,and the proportion of multiple cerebral contusion,intracranial hematoma volume,proportion of merging cerebral hernia,plasma D-D,Fib,CRP,the proportion of patients with improved CT image scores of 9 to 14 and average score,the proportion of poor prognosis and average GOS were higher(P<0.05). Compared with good prognosis group,in poor prognosis group MPV,D-D,CRP,Fib,and improved CT image scores were higher(P<0.05). Pearson correlation analysis showed that MPV was positively correlated with intracranial hematoma volume,D-D,CRP,Fib,improved CT image score and PDW,and negatively correlated with GOS and PLT(P<0.05). Multiple Logistic regression equation showed that MPV was an independent risk factor for poor prognosis(OR=1.957,P=0.009). The ROC curve showed that AUC of poor prognosis predicted by MPV was 0.859,sensitivity and specificity were 83.71% and 85.74%,optimal diagnostic cut-off point was 13.20 fl. Conclusion:Increased level of MPV in acute phase may be an independent predictor of poor prognosis,changes of MPV level should be closely monitored. It is suggested to use it as one of auxiliary reference indexes for evaluation of patients’ condition and prognosis.

关 键 词：血小板平均体积 颅脑损伤 格拉斯哥预后评分 预后 对比研究 

分 类 号：R651.1[医药卫生—外科学]