平均血小板体积预测接受静脉溶栓治疗的急性缺血性卒中患者的早期神经功能恶化  

Mean platelet volume predicts early neurological deterioration in patients with acute ischemic stroke treated with intravenous thrombolysis

作　　者：蔡峻[1] 李昀泽[1] 梁森[1] 姚蓓蓓[1] 骆守真[1] 蒋辉[1] Cai Jun;Li Yunze;Liang Sen;Yao Beibei;Luo Shouzhen;Jiang Hui(Department of Neurology,Jiangsu Provincial Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院神经内科,南京210029

出　　处：《国际脑血管病杂志》2020年第5期343-347,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨平均血小板体积(mean platelet volume,MPV)对急性缺血性卒中患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的预测价值。方法回顾性纳入2016年9月至2019年12月在江苏省中医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者。入院后即刻采用血细胞分析仪检测MPV水平。END定义为入院7 d内任意一次美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分。采用单变量分析比较END组与非END组间基线资料的差异,同时采用多变量logistic回归分析确定END的独立危险因素。应用受试者工作特征(receiver operator characteristic,ROC)曲线评估MPV对END的预测价值。结果共纳入103例患者,年龄(68.0±13.3)岁,男性80例(77.7%)。END组28例(27.2%),非END组75例(71.8%)。END组缺血性心脏病比例(28.6%对9.3%;χ^2=6.065,P=0.014)、基线NIHSS评分[8.5(4.0~16.5)分对5.0(3.0~11.0)分;Z=2.198,P=0.028]、有症状颅内出血比例(1.9%对0%;χ^2=5.463,P=0.019)、低密度脂蛋白胆固醇[2.9(2.2~3.4)mmol/L对2.4(1.8~3.1)mmol/L;Z=2.165,P=0.030]、高敏C反应蛋白[7.0(1.2~36.0)mg/L对2.1(1.0~6.0)mg/L;Z=2.159,P=0.031]及MPV水平[(10.4±1.3)fl对(9.5±1.2)fl;t=2.771,P=0.007]均显著高于非END组。多变量logistic回归分析显示,在校正混杂因素后,MPV较大是END的独立预测因素(优势比1.668,95%可信区间1.079~2.579;P=0.021)。ROC曲线分析显示,MPV对END具有一定预测价值(曲线下面积0.653,95%可信区间0.533~0.774)。其最佳截断值为10.2 fl,此时的敏感性和特异性分别为57.4%和70.3%。结论基线MPV较大对急性缺血性卒中静脉溶栓后END有一定的预测价值。Objective To investigate the predictive value of mean platelet volume(MPV)for early neurological deterioration(END)after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke treated with intravenous thrombolysis in the Department of Neurology,Jiangsu Provincial Hospital of Chinese Medicine from September 2016 to December 2019 were enrolled retrospectively.Immediately after admission,hematology analyzer was used to detect the MPV level.END was defined as the National Institutes of Health Stroke Scale(NHISS)score at any time point within 7 d after the admission increased by≥2 from baseline.Univariate analysis was used to compare the differences in baseline data between the END group and the non-END group,and multivariate logistic regression analysis was used to determine the independent risk factors for END.The receiver operator characteristic(ROC)curve was used to evaluate the predictive value of MPV for END.Results A total of 103 patients were enrolled.Their age was 68.0±13.3 years old,and 80 were male(77.7%).There were 28 patients(27.2%)in the END group and 75(71.8%)in the non-END group.The proportion of ischemic heart disease(28.6%vs.9.3%;χ^2=6.065,P=0.014),baseline NIHSS score(8.5[4.0-16.5]vs.5.0[3.0-11.0];Z=2.198,P=0.028),symptomatic intracranial hemorrhage(1.9%vs.0%;χ^2=5.463,P=0.019),low-density lipoprotein cholesterol(2.9[2.2-3.4]mmol/L vs.2.4[1.8-3.1]mmol/L;Z=2.165,P=0.030),high-sensitivity C-reactive protein(7.0[1.2-36.0]mg/L vs.2.1[1.0-6.0]mg/L;Z=2.159,P=0.031)and MPV levels(10.4±1.3 fl vs.9.5±1.2 fl,t=2.771,P=0.007)of the END group were significantly higher than those of the non-END group.Multivariate logistic regression analysis showed that after adjusting for the confounding factors,the larger MPV was an independent predictor of END(odds ratio 1.668,95%confidence interval 1.079-2.579;P=0.021).ROC curve analysis showed that MPV had a certain predictive value for END(area under the curve,0.653,95%confidence interval 0.533-0.774).Its optimal

关 键 词：卒中 脑缺血 平均血小板体积 血栓溶解疗法 疾病恶化 试验预期值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]