急性脑梗死患者血小板参数变化对静脉溶栓后出血转化的预测分析  

Predictive Analysis of Changes of Platelet Parameters in Patients with Acute Cerebral Infarction on Hemorrhage Transformation after Intravenous Thrombolysis

作　　者：刘晓明 翟韶 赵会玲 Liu Xiao-ming;Zhai Shao;Zhao Hui-ling(The Third People's Hospital of Puyang,Department of Clinical Laboratory,Puyang 457000,Henan Province,China)

机构地区：[1]濮阳市第三人民医院检验科,河南濮阳457000

出　　处：《罕少疾病杂志》2023年第8期24-26,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨急性脑梗死(ACI)患者血小板参数变化与静脉溶栓后出血转化(HT)的关系。方法采用前瞻性研究,选择2021年3月至2022年3月濮阳市第三人民医院收治的ACI患者89例,统计静脉溶栓后48h内HT发生情况并分组,比较两组患者一般资料,入院时凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)],入院时及静脉溶栓2h后血小板参数[血小板数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)],Logistic回归分析ACI患者静脉溶栓后HT的独立危险因素。根据受试者工作特征曲线(ROC曲线),评价血小板参数变化对ACI患者接受静脉溶栓后48h内出现HT风险的预测价值。结果89例ACI患者静脉溶栓治疗后48h内发生HT 22例(24.72%),发生组凝血功能指标(PT、TT、APTT、FIB)高于未发生组(P<0.05);入院时及溶栓2h后,未发生组患者PLT值均明显高于发生组患者,MPV、PDW值均明显低于发生组,且参数变化幅度均高于发生组(P<0.05);Logistic回归分析,结果显示,PLT、MPV、PDW差值大是HT发生的保护因素(OR<1,P<0.05);绘制ROC曲线,结果显示,PLT差值、MPV差值、PDW差值预测HT发生的AUC为(0.728、0.725、0.796),具有一定的预测价值,且联合预测价值较高(AUC=0.901)。结论ACI患者血小板参数变化与静脉溶栓后HT发生有关,且具有良好的预测价值,对临床预测ACI患者静脉溶栓后预后具有参考价值。Objective To investigate the relationship between changes of platelet parameters and hemorrhage transformation(HT)after intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods A prospective study was conducted to select 89 ACI patients admitted to the Third People's Hospital of Puyang from March 2021 to March 2022.The occurrence of HT within 48 hours after intravenous thrombolysis was counted and grouped.The general data,coagulation function indexes[thrombin time(TT),prothrombin time(PT),fibrinogen(FIB),activated partial thromboplastin time(APTT)]at admission,platelet parameters[platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW)]at admission and 2 hours after intravenous thrombolysis were compared between the two groups.Logistic regression analysis was used to analyze the independent risk factors of HT after intravenous thrombolysis in ACI patients.According to the receiver operating characteristic curve(ROC curve),the predictive value of platelet parameter changes on the risk of HT in ACI patients within 48 hours after intravenous thrombolysis was evaluated.Results HT occurred in 22 cases(24.72%)within 48 hours after intravenous thrombolytic therapy in 89 patients with ACI.The coagulation function indexes(PT,TT,APTT,FIB)in the occurrence group were higher than those in the non occurrence group(P<0.05).At admission and 2h after thrombolysis,PLT values of patients in the non occurrence group were significantly higher than those in the occurrence group,MPV and PDW values were significantly lower than those in the occurrence group,and the change range of parameters was higher than that in the occurrence group(P<0.05).Logistic regression analysis showed that the difference of PLT,MPV and PDW was a protective factor for HT(OR<1,P<0.05).ROC curve was drawn.The results showed that the AUC of PLT difference,MPV difference and PDW difference in predicting HT was(0.728,0.725,0.796),which had certain predictive value,and the combined predictive value was higher(AUC=0.901)

关 键 词：急性脑梗死 血小板参数 静脉溶栓 出血转化 预测 

分 类 号：R742[医药卫生—神经病学与精神病学] R543[医药卫生—临床医学]