急性缺血性脑卒中患者静脉溶栓后血小板参数对不良预后的预测价值  

Predictive value of platelet parameters on poor prognosis in patients with acute ischemic stroke after intravenous thrombolysis

作　　者：崔东慧 杨凡[1] 张立铖 贺绚 梁雪原 马军[1] CUI Donghui;YANG Fan;ZHANG Licheng;HE Xuan;LIANG Xueyuan;MA Jun(The First Central Hospital of Baoding,Baoding 071000,China)

机构地区：[1]保定市第一中心医院,河北保定071000

出　　处：《中国实用神经疾病杂志》2024年第9期1107-1111,共5页Chinese Journal of Practical Nervous Diseases

基　　金：保定市科技计划项目(编号:2241ZF053)。

摘　　要：目的探讨急性缺血性脑卒中患者静脉溶栓后血小板参数水平对不良预后的预测价值。方法纳入保定市第一中心医院110例急性缺血性脑卒中患者进行研究,所有患者行静脉溶栓治疗,均在溶栓治疗后测定血小板参数,治疗后随访3个月,根据改良Rankin量表(mRS)评估患者预后,将mRS≥3分者纳入预后不良组(n=32),mRS<3分者纳入预后良好组(n=78),比较2组一般资料、血小板参数、分析影响急性缺血性脑卒中静脉溶栓治疗患者不良预后的危险因素及血小板参数对不良预后的预测价值。结果预后不良组年龄、入院NIHSS评分、血清TG、LDL-C、PT、Fib水平显著高于预后良好组(P<0.05),2组性别、BMI、吸烟史、饮酒史、并发症、TOAST分型、梗死部位、血清TC、HDL-C、TT、APTT、Scr水平无统计学差异(P>0.05);预后不良组PLT、PDW、MPV水平显著高于预后良好组(P<0.05);入院NIHSS评分、PT、PLT、PDW、MPV是影响急性缺血性脑卒中患者静脉溶栓治疗预后的危险因素(P<0.05);PLT、PDW、MPV单独及联合预测急性缺血性脑卒中患者静脉溶栓治疗不良预后的敏感度为81.25%、84.38%、81.25%、93.75%,特异度为61.54%、70.51%、65.38%、61.54%,AUC为0.749、0.816、0.745、0.921。结论急性缺血性脑卒中患者静脉溶栓后血小板参数PLT、PDW、MPV与患者预后呈显著相关性,可用于预测患者预后。Objective To explore the predictive value of platelet parameters after intravenous thrombolysis on poor prognosis in patients with acute ischemic stroke(AIS).Methods Totally 110 patients with AIS in the hospital were enrolled in the study and received intravenous thrombolysis Platelet parameters were measured after thrombolytic therapy in all patients.At 3 months of follow-up after treatment,and the prognosis was evaluated according to modified Rankin scale(mRS).The patients with mRS≥3 points were included in poor prognosis group(n=32),and the patients with mRS<3 points were enrolled as good prognosis group(n=78).The general data and platelet parameters were compared,and the risk factors affecting the poor prognosis of AIS patients with intravenous thrombolytic therapy and the predictive value of platelet parameters on poor prognosis were analyzed.Results The age,NIHSS score at admission,and serum TG,LDL-C,PT and Fib levels in poor prognosis group were significantly higher(P<0.05),but there were no significant differences in gender,BMI,smoking history,drinking history,comorbidity,TOAST classification,infarction location,serum TC,HDL-C,TT,APTT and Scr between the two groups(P>0.05).Compared with good prognosis group,the PLT,PDW and MPV were significantly higher in poor prognosis group(P<0.05).NIHSS score at admission,PT,PLT,PDW and MPV were risk factors affecting the prognosis of intravenous thrombolytic therapy in AIS patients(P<0.05).The sensitivities of PLT,PDW and MPV alone and in combination in predicting poor prognosis of AIS patients after intravenous thrombolytic therapy were 81.25%,84.38%,81.25 and 93.75%,and the specificities were 61.54%,70.51%,65.38%and 61.54%,and the AUCs were 0.749,0.816,0.745 and 0.921,respectively.Conclusion The platelet parameters PLT,PDW and MPV after intravenous thrombolysis are significantly correlated with the prognosis of AIS patients,and can be used to predict the prognosis of patients.

关 键 词：急性缺血性脑卒中 静脉溶栓 血小板计数 血小板分布宽度 血小板体积 血小板比积 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]