红细胞分布宽度对急性缺血性卒中患者静脉溶栓转归的预测价值

Predictive value of red blood cell distribution width for outcome of intravenousthrombolysis in patients with acute ischemic stroke

目的探讨红细胞分布宽度(RDW)对急性缺血性卒中(AIS)患者静脉溶栓转归的预测价值.方法分析2017年1月—2019年1月期间天津医科大学第二医院神经内科接受静脉溶栓治疗的122例AIS患者,溶栓后3个月时应用改良Rankin量表(mRS)评估临床转归,0~2分为转归良好,>2分为转归不良.比较2组患者临床基线资料及相关实验室检查指标,应用多变量Logistic回归分析影响转归不良的危险因素,通过绘制受试者工作特征(ROC)曲线评价RDW对AIS患者静脉溶栓转归不良的预测价值.结果122例患者中转归良好69例(56.6%),转归不良53例(43.4%),转归不良组合并高血压史、卒中史、心脏病史、房颤史的比例以及年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、空腹血糖(FBG)、超敏C反应蛋白(hs-CRP)、尿酸(UA)、RDW值均高于转归良好组(P<0.05).多变量Logistic回归分析显示,高FBG、入院高NIHSS评分以及RDW水平升高是转归不良的危险因素,以RDW为变量对转归不良预测效能的ROC曲线下面积为0.754(95%CI:0.665~0.843),RDW预测AIS静脉溶栓转归不良的截断值为13.15%,敏感度为62.3%,特异度为84.1%.结论高RDW水平是AIS患者静脉溶栓转归不良的独立危险因素,RDW对AIS患者静脉溶栓转归有一定的预测价值.

Objective To explore the predictive value of red blood cell distribution width(RDW)for the outcome of intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods A total of 122 patients with AIS admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University for the treatment of intravenous thrombolysis between January 2017 and January 2019 were enrolled retrospectively.Three months after treatment,the clinical outcome was assessed by the modified Rankin scale(mRS).The score of 0-2 was defined as good outcome,and>2 was defined as poor outcome.Clinical basic data,blood count and biochemical data were compared between the two groups.Multivariate Logistic regression analysis was used to determine the independent risk factors for poor outcome.Receiver operator characteristic(ROC)curve was used to analyze the predictive value of RDW for poor outcome after intravenous thrombolysis in patients with AIS.Results In 122 patients,69(56.6%)showed good outcome and 53(43.4%)showed poor outcome.The proportions of hypertension,stroke,heart disease,atrial fibrillation and the values of age,baseline National Institutes of Health Stroke Scale(NIHSS)score,fasting blood glucose(FBG),high sensitivity C-reactive protein(hs-CRP),uric acid(UA)and RDW were significantly higher in poor outcome group than those in good outcome group(P<0.05).Multivariate Logistic regression analysis showed that high FBG level,high NIHSS score and elevated RDW were the independent risk predictors of poor outcome after intravenous thrombolysis in patients with AIS.The cutoff RDW value for predicting poor outcome after intravenous thrombolysis in patients with AIS was more than 13.15%with a sensitivity of 62.3%and a specificity of 84.1%(area under the curve,0.754;95%confidence interval 0.665-0.843).Conclusion The elevated RDW is an independent risk factor for poor outcome after intravenous thrombolysis in patients with AIS.RDW has a certain predictive value for outcome after intravenous thrombolysis in patients with AIS.