血小板反应性预测急性缺血性卒中患者的早期神经功能恶化

Platelet reactivity predicts early neurological deterioration in patients with acute ischemic stroke

目的探讨血小板反应性对急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的预测价值。方法前瞻性纳入2017年1月至2019年3月在发病48 h内入住中南大学湘雅医学院附属海口医院神经内科的急性缺血性卒中患者。入院当日即服用阿司匹林,服用7 d后使用PL-11血小板功能分析仪检测血小板聚集率。END定义为入院7 d内复评美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NHISS)的最高分较入院时增加≥2分或运动项评分增加≥1分。比较END组与非END组患者的人口统计学、基线资料、影像学检查和实验室检查结果。采用多变量logistic回归分析确定END的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血小板聚集率对END的预测价值。结果共纳入230例患者,年龄(63.24±9.75)岁,女性126例(51.4%);中位基线NIHSS评分6分(四分位数间距4~10分),中位发病至入院时间15 h(四分位数间距9~28 h)。END组54例(23.5%),非END组176例(76.5%)。END组花生四烯酸诱导血小板最大聚集率(arachadonic acid-induced maximum platelet aggregation ratio,MAR-AA)、肾上腺素诱导血小板最大聚集率(epinephrine-induced maximum platelet aggregation ratio,MAR-EPI)和胶原诱导血小板最大聚集率(collagen-induced maximum platelet aggregation ratio,MAR-COL)与非END组存在显著差异(P均<0.05)。多变量logistic回归分析显示,MAR-AA[优势比(odds ratio,OR)1.165,95%可信区间(confidence interval,CI)1.091~1.243;P<0.001]和MAR-EPI(OR 1.035,95%CI 1.006~1.067;P=0.023)为急性缺血性卒中发生END的独立危险因素。ROC曲线分析显示,MAR-AA对END具有较好的预测价值,其ROC曲线下面积为0.775(95%CI 0.707~0.843;P<0.001),最佳截断值为21.80%,其预测END的敏感性和特异性分别为72.2%和77.3%。结论PL-11测定的血小板功能与急性缺血性卒中患者发生END的风险密切相关,对END具有较好的预测价值。

Objective To investigate the predictive value of platelet reactivity for early neurological deterioration (END) in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke within 48 h of onset admitted to the Department of Neurology, the Affiliated Haikou Hospital of Xiangya School of Medicine, Central South University from January 2017 to March 2019 were enrolled prospectively. Aspirin was taken on the day of admission, and the platelet aggregation rate was detected using a PL-11 Platelet Function Analyzer 7 d after taking it. END was defined as the National Institutes of Health Stroke Scale (NHISS) score at any time point within 7 d after admission increased by ≥2 or the motor function item score increased by ≥1 from baseline. The demographics, baseline data, imaging examination and laboratory findings of patients in the END and non-END groups were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of platelet aggregation rate for END.Results A total of 230 patients were included in the study. They aged 63.24±9.75 years, 126 were females (51.4%). The median baseline NIHSS score was 6 (interquartile range, 4-10). The median time from onset to admission was 15 h (interquartile range, 9-28 h). There were 54 patients (23.5%) in the END group and 176 (76.5%) in the non-END group. There were significant differences in arachidonic acid-induced maximum platelet aggregation ratio (MAR-AA), epinephrine-induced maximum platelet aggregation ratio (MAR-EPI) and collagen-induced maximum platelet aggregation ratio (MAR-COL) between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MAR-AA (odd ratio [OR] 1.165, 95% confidence interval [CI] 1.091-1.243;P<0.001) and MAR-EPI (OR 1.035, 95% CI 1.006-1.067;P=0.023) were the independent risk factors for END in patients with acute ischemic stroke. ROC curve analysis showed that MAR-AA had good predictive value for END, and the area under the curve was 0.775 (95% CI 0.707-0.843;P<0.001). The optimal cut-off value was 21.80%. The sensitivity and specificity of MAR-AA for predicting END were 72.2% and 77.3%, respectively.Conclusions The platelet function measured by PL-11 is closely related to the risk of END in patients with acute ischemic stroke. It has a better predictive value for END.