摘要
目的研究抗栓治疗后血小板参数对非心源性脑梗死(NCCI)预后的预测价值。方法71例NCCI患者,所有患者均于入院首日抗栓之前完成血小板参数[血小板分布宽度(PDW)、平均血小板体积(MPV)、血小板计数(PLT)、PDW/PLT、MPV/PLT]测定。抗栓7 d后,所有NCCI患者均完善PDW、MPV、PLT、PDW/PLT、MPV/PLT复查,分别以PLT7、PDW7、MPV7、MPV7/PLT7、PDW7/PLT7表示。选取改良Rankin量表(MRS)对患者6个月时神经功能恢复情况做出评估,根据预后评估结果分为预后不良组(MRS评分>2分,10例)与预后良好组(MRS评分≤2分,61例)。①比较两组一般资料及血化验结果;②采用多因素Logistic回归分析NCCI患者抗栓7 d后预后不良的危险因素;③采用受试者工作特征曲线(ROC曲线)分析阳性指标对NCCI患者预后的预测价值。结果抗栓后,61例患者预后良好,10例患者预后不良。两组患者年龄、性别、饮酒、吸烟、冠心病、糖尿病、高血压、白细胞计数、尿酸、尿素氮、肌酐、同型半胱氨酸、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、总胆固醇、MPV、PDW、PLT7、PDW/PLT水平比较差异无显著性(P>0.05)。预后不良组患者PLT(157.72±46.53)×10^(9)/L明显低于预后良好组的(195.04±55.42)×10^(9)/L,MPV/PLT(0.77±0.14)×10^(-10)fl/L明显高于预后良好组的(0.61±0.23)×10^(-10)fl/L,差异有显著性(P<0.05);预后不良组患者MPV7、MPV7/PLT7、PDW7、PDW7/PLT7分别为(14.72±4.07)fl、(0.73±0.23)×10^(-10)fl/L、(11.63±1.48)fl、(0.92±0.39)×10^(-10)fl/L,明显高于预后良好组的(12.29±3.26)fl、(0.52±0.21)×10^(-10)fl/L、(9.81±1.58)fl、(0.71±0.25)×10^(-10)fl/L,差异有显著性(P<0.05)。将单因素分析中显示差异有显著性的因素(PLT、MPV/PLT、PDW7、PDW7/PLT7、MPV7、MPV7/PLT7)纳入多因素Logistic回归分析,结果显示:MPV7为NCCI患者预后不良的危险因素[OR=7.668,95%CI=(1.526,38.527),P=0.012<0.05]。ROC曲线显示:MPV7对NCCI患者的预后具有预测价值,以10.13 fl为临界值,MPV7预测NCCI患者预后不良的曲线下面积(AUC)为0.786[95%CI=(0.677,0.896),P=0.001<0.05],灵敏度为83.33%,特异度为69.50%。结论抗栓7 d后MPV为NCCI患者预后不良的危险因素,可辅助预测NCCI预后情况。
Objective To study the predictive value of platelet parameters on the prognosis of non-cardiogenic cerebral infarction(NCCI)after anti-thrombotic therapy.Methods 71 patients with NCCI were selected.All patients completed detection of platelet parameters[platelet distribution width(PDW),mean platelet volume(MPV),platelet(PLT),PDW/PLT,MPV/PLT)before anti-thrombolysis on the first day of admission.After 7 d of anti-thrombotic therapy,all NCCI patients underwent PDW,MPV,PLT,PDW/PLT,MPV/PLT re-examination,which were expressed as PLT7,PDW7,MPV7,MPV7/PLT7,PDW7/PLT7,respectively.Modified Rankin scale(MRS)was used to evaluate the neurological function recovery of patients at 6 months.According to the results of prognosis evaluation,patients were divided into poor prognosis group(MRS score>2 points,10 cases)and good prognosis group(MRS score≤2 points,61 cases).(i)General information and blood test results of the two groups were compared;(ii)Multivariate Logistic regression was used to analyze the risk factors of poor prognosis in NCCI patients after 7 d of anti-thrombotic therapy;(iii)Receiver operating characteristic(ROC)curve was used to analyze the prognostic value of positive indicators in NCCI patients.Results After antithrombotic treatment,61 patients had good prognosis and 10 patients had poor prognosis.There was no significant difference in the comparison of age,gender,alcohol consumption,smoking,coronary heart disease,diabetes,hypertension,white blood cell count,uric acid,urea nitrogen,creatinine,homocysteine,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,triglycerides,total cholesterol,MPV,PDW,PLT7,and PDW/PLT levels between the two groups(P>0.05).The PLT in the poor prognosis group was(157.72±46.53)×10^(9)/L,which was significantly lower than(195.04±55.42)×10^(9)/L in the good prognosis group;MPV/PLT in the poor prognosis group was(0.77±0.14)×10^(-10)fl/L,which was significantly higher than(0.61±0.23)×10^(-10)fl/L in the good prognosis group.The difference was significant(P<0.05).In the poor prognosis group,MPV7,MPV7/PLT7,PDW7 and PDW7/PLT7 were(14.72±4.07)fl,(0.73±0.23)×10^(-10)fl/L,(11.63±1.48)fl and(0.92±0.39)×10^(-10)fl/L,which were significantly higher than(12.29±3.26)fl,(0.52±0.21)×10^(-10)fl/L,(9.81±1.58)fl and(0.71±0.25)×10^(-10)fl/L in the good prognosis group,and the difference was significant(P<0.05).The factors(PLT,MPV/PLT,PDW7,PDW7/PLT7,MPV7,MPV7/PLT7)that showed significant differences in univariate analysis were included in multivariate logistic regression analysis,and the results showed that MPV7 was a risk factor for poor prognosis in NCCI patients[OR=7.668,95%CI=(1.526,38.527),P=0.012<0.05].The ROC curve showed that MPV7 had a predictive value for the prognosis of NCCI patients.With MPV=10.13 fl as the critical value,the area under the curve(AUC)of MPV7 for predicting a poor prognosis in NCCI patients was 0.786[95%CI=(0.677,0.896),P=0.001<0.05],the sensitivity was 83.33%,and the specificity was 69.50%.Conclusion MPV value after 7 d of antithrombotic therapy is a risk factor for poor prognosis in patients with NCCI,and can help predict the prognosis of NCCI.
作者
徐迎春
XU Ying-chun(Department of Neurology,Jiaxiang County People's Hospital,Jining 272400,China)
出处
《中国实用医药》
2024年第14期15-19,共5页
China Practical Medicine
关键词
非心源性脑梗死
抗栓治疗
血小板分布宽度
平均血小板体积
血小板计数
Non-cardiogenic cerebral infarction
Anti-thrombotic therapy
Platelet distribution width
Mean platelet volume
Platelet count
