血小板聚集率对急性脑梗死诊断价值及发病关系的探讨

The diagnostic value of platelet aggregation rate and the relationship with acute cerebral infarction

目的观察急性脑梗死患者血小板最大聚集率（MAR）水平，分析其诊断价值和发病的关系。方法急性脑梗死组120例，健康对照组50例。入院次日晨空腹采血，透射比浊法测定花生四烯酸诱导MAR（MARAn）和二磷酸腺苷诱导MAR（MAR_ADP）。结果脑梗死组MAR_AA为62．9±17．6（％）、MAR_ADP为66．8±14．2（％），健康对照组为56．6±14．1、60．1±13．5，组间t检验均有统计学意义（P〈0．05）；MAR_AA与MAR_ADP以及不同性别间MAR水平差异均无统计学意义（P〉0．05）。患者发病年龄与MAR以及MAR_AA与MAR_ADP无直线性关联（r≤0．1）。受试者工作特征曲线确定Cutoff，MAR_AA为57％，AUC为0．61，诊断正确率为88％；MAR_ADP分别为60％、0．62、58％。65．4％左右患者MAR〉Cutoff，10％左右超出正常参考值上限，12．5％左右低水平。logistic回归分析：OR值MAR_AA为3．026，有统计学意义（P=0．0017）。MAR_ADP为1．058，无统计学意义（P=0．906）。结论急性脑梗死患者MAR水平上调，无性别差异，与年龄无关。MAR诊断价值低，高水平MAR_AA是脑梗发病的独立危险因子。脑卒中的预防和治疗ASA与氯吡格雷应同时给药，但应监测MAR，个体化用药。

Objective We observed platelet aggregation rate in patients with acute cerebral infarction and analyze the diagnostic value and the relationship with ACI. Methods 120 patients with acute cerebral infarction and 50 normal control subjects were in our study. The venous blood samples were collected on the second day after admission, determining the MAR_AA and MARADP by transmission turbidimetry. Results MAR was 62.9±17.6 （%） induced by AA and 66.8±14.2（%） induced by ADP in the disease group; MAR was 56.6±14.1（%） induced by AA and 60.1±13.5（%） induced by ADP in the control group. There was a statistically significant between the patients group and the control group （P〈0.05）. No statistically significant differences were noted between MAR_AA and MARADP （P〉0.05）. There was no linear correlation between MARADP and MAR_AA or between MAR and age of onset of ACI. The cut off point of MAR_AA according to ROC curve was 57% and AUC was 0.61and the accuracy was 88%. The cut off value of MARADP according to ROC curve was 60% and AUC, accuracy were 0.62,58% respectively. The MAR in 65.4% of the patients were higher than the cut off value and 10% than the upper reference limit. Logistic regression analysis showed MAR_AA （OR=3.026, P=0.0017） was statistically significant. MARADp（OR=1.058, r^2=0.906 ） was no statistically significant. Conclusion The MAR level increased in the patients with acute cerebral infarction and was not correlated with gender or age. The diagnostic value of MAR is low. High level MAR_AA is an independent risk factor for acute cerebral infarction. Both Aspirin and Clopidogrel are advised on prevention and treatment for ACI and MAR should be monitored actively.