相关炎性因子对静脉窦血栓患者预后的预测价值研究

Prognostic value of related inflammatory factors in patients with venous sinus thrombosis

目的本研究旨在探讨血小板淋巴细胞比值(Platelet to Lymphocyte ratio,PLR)、D-二聚体及红细胞分布宽度与静脉窦血栓(cerebral venous sinus thrombosis,CVST)患者预后的相关性。方法回顾性纳入郑州大学第一附属医院自2010-11—2017-01收治的CVST患者。收集患者的人口学信息、症状、实验室指标、影像学资料以及出院随访患者改良Rankin量表(mRS)评分。mRS≤2定义为预后良好。使用多因素logistic回归分析,比较CVST患者预后与三种因子水平的关系,应用受试者工作特征曲线(ROC)评价预测价值。结果纳入228例CVST住院患者,187例(82.0%)患者预后良好,41例(18.0%)患者预后不良。单因素分析结果显示预后不良组PLR值显著高于预后良好组(267.2±175.6vs 160.1±86.9,P <0.001),D-二聚体(1.5±2.4vs 4.2±9.8,P=0.09)和红细胞分布宽度(15.3±4.1vs 14.8±2.7,P=0.3)在2组患者间差异无统计学意义。多因素分析结果显示年龄[优势比(odds ratio,OR)1.060,95%可信区间(confidence interval,CI)1.027～1.094,P<0.05]、意识障碍(OR2.497,95%CI 0.971～6.421,P=0.05)颅内出血(OR 5.361,95%CI 1.977～14.541,P=0.001)、PLR(OR 1.007,95%CI 1.003～1.011,P=0.001)、直窦(OR 2.757,95%CI 1.121～6.780,P=0.027)、静脉(OR 4.250,95%CI 1.450～12.454,P=0.008)和预后独立相关。受试者工作特征(ROC)曲线分析显示PLR为168.3时,预测CVST预后不良的敏感度和特异度78.0%和65.2%。结论 PLR与CVST患者预后独立相关。D-二聚体以及红细胞分布宽度不是CVST患者的独立危险因素。

Objective To investigate the relationship between platelet to lymphocyte ratio(PLR),D Dimer and red cell volume distribution width and cerebral venous sinus thrombosis(CVST)outcomes.Methods CVST patients admitted to the First Affiliated Hospital of Zhengzhou University,were retrospectively identified from November 2010 to January 2017.Functional outcomes of patients were evaluated with the modified Rankin Scale(mRS).Patients were divided into good(mRS 0-2)and poor(mRS 3-6)outcomes group.Multivariate logistic regression analysis was used to assess the relationship between related inflammatory factors and the outcomes.A receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of related inflammatory factors for predicting the outcomes in CVST.Results A total of 228 patients were included of which 41 had poor outcomes(18.0%).PLR(267.2±175.6 vs 160.1±86.9,P<0.001)was higher in the poor group.However,there were no significant differences between the two groups with respect to D Dimer(1.5±2.4 vs 4.2±9.8,P=0.09)and red cell volume distribution width(15.3±4.1 vs 14.8±2.7,P=0.3).Mutiple logistic regression analysis identified age(OR 1.060,95% CI 1.027 1.094,P<0.05),coma(OR 2.497,95% CI 0.971-6.421,P=0.05),intracerebral hemorrhage(OR 5.361,95% CI 1.977 14.541,P=0.001),PLR(OR 1.007,95% CI 1.003-1.011,P=0.001),straight sinus(OR 2.757,95% CI 1.121-6.780,P=0.027)and venous(OR 4.250,95% CI 1.450-12.454,P=0.008)as independent predictors of poor prognosis.A receiver operating characteristic curve showed that the cut off value of the PLR was 168.3.The sensitivity and specificity were 78.0% and 65.2%,respectively.Conclusion PLR was an independent predictor of poor prognosis in CVST patients while D Dimer and red cell volume distribution width were not.