血小板聚集率预测急性缺血性卒中患者静脉溶栓后早期神经功能恶化  

Platelet aggregation rate predicts early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：张江山 张植兰 杨国帅[1] 侯丹[1] 胡裕洁 Zhang Jiangshan;Zhang Zhilan;Yang Guoshuai;Hou Dan;Hu Yujie(Department of Neurology,Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China;Interventional Department,Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院神经内科,海口570208 [2]中南大学湘雅医学院附属海口医院介入科,海口570208

出　　处：《国际脑血管病杂志》2023年第8期561-568,共8页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨血小板聚集率对急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓(intravenous thrombolysis,IVT)后早期神经功能恶化(early neurological deterioration,END)的预测价值。方法回顾性连续纳入2020年11月至2023年7月在中南大学湘雅医学院附属海口医院神经内科接受静脉溶栓治疗的AIS患者。采用PL-12多参数血小板功能分析仪检测血小板最大聚集率(maximum platelet aggregation rate,MAR)。END定义为IVT后24 h内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线时增加≥4分。比较END组与非END组人口统计学、基线资料、实验室检查和影像学检查结果,观察IVT前、IVT后即刻和IVT后2 h时花生四烯酸(arachidonic acid,AA)和二磷酸腺苷(adenosine diphosphate,ADP)诱导的MAR动态变化。采用多变量logistic回归分析确定END的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析不同时间点MAR对END的预测价值。结果共纳入300例患者,年龄(64.88±8.82)岁,中位基线NIHSS评分11分(四分位数间距:8~15分),发病至溶栓时间(172.03±53.96)min,66例(22.0%)发生END。END组IVT前、IVT后即刻以及IVT后2 h时MAR-AA和MAR-DP均显著高于非END组(P均<0.05)。多变量logistic回归分析显示,IVT后2 h时MAR-AA(优势比1.098,95%置信区间1.039~1.161;P<0.001)和MAR-ADP(优势比1.100,95%置信区间1.038~1.167;P<0.001)均为END的独立危险因素。ROC曲线分析显示,IVT前、IVT后即刻以及IVT后2 h时MAR-AA和MAR-ADP对END均具有较好的预测价值,其中IVT后2 h时MAR-AA和MAR-ADP对应的曲线下面积最大,分别为0.745和0.710。MAR-AA的最佳截断值为39.28%,预测END的敏感性和特异性分别为74.2%和76.1%;MAR-ADP的最佳截断值为43.35%,预测END的敏感性和特异性分别为69.7%和66.2%。结论PL-12测定的MAR与AIS患者IVT治疗后END风险密切相关,而且对END具有较好的预测价值。Objective To investigate the predictive value of platelet aggregation rate for early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods Consecutive patients with AIS received IVT at the Department of Neurology,Haikou Hospital Affiliated to Xiangya School of Medical,Central South University from November 2020 to July 2023 were retrospectively included.The maximum platelet aggregation rate(MAR)was measured using the PL-12 multi-parameter platelet function analyzer.END was defined as an increase of≥4 from baseline in the National Institutes of Health Stroke Scale(NIHSS)score within 24 h after IVT.The demographic,baseline data,laboratory findings,and imaging results between the END and non-END groups were compared,and the dynamic changes in MAR induced by arachidonic acid(AA)and adenosine diphosphate(ADP)before,immediately after,and 2 h after IVT were observed.Multivariate logistic regression analysis was used to determine the independent risk factors for END.Receiver operating characteristic(ROC)curves were used to analyze the predictive value of MAR for END at different time points.Results A total of 300 patients were included,aged 64.88±8.82 years,with a median baseline NIHSS score of 11(interquartile range,8-15)and the onset-to-needle time was 172.03±53.96 min.Among them,66 patients(22.0%)developed END.The MAR-AA and MAR-DP levels before,immediately after,and 2 h after IVT in the END group were significantly higher than those in the non-END group(all P<0.05).Multivariate logistic regression analysis showed that MAR-AA(odds ratio 1.098,95%confidence interval 1.039-1.161;P<0.001)and MAR-ADP(odds ratio 1.100,95%confidence interval 1.038-1.167;P<0.001)at 2 h after IVT were the independent risk factors for END.ROC curve analysis shows that MAR-AA and MAR-ADP before,immediately after,and 2 h after IVT had good predictive value for END.Among them,the area under the curve corresponding to MAR-AA and MAR-ADP at 2 h after IVT was the largest,with values

关 键 词：缺血性卒中 血栓溶解疗法 疾病恶化 血小板聚集 试验预期值 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]