血浆D-二聚体及血小板/淋巴细胞比值对急性缺血性脑卒中青年患者预后的预测作用

Predictive effect of plasma D-dimer and platelet/lymphocyte ratio on prognosis in young patients with acute ischemic stroke

目的探讨血浆D-二聚体(D-D)及血小板/淋巴细胞比值(PLR)对急性缺血性脑卒中(AIS)青年患者预后的预测作用。方法选取接受静脉注射重组组织纤溶酶原激活剂治疗的动脉硬化性AIS患者90例,根据术后3个月的改良Rankin量表(MRS)评分将患者分为预后良好组和预后不良组,计算PLR和测定D-D的水平,分析二者与AIS青年患者临床病理参数间的关系,进行多因素logistic回归分析探讨AIS患者预后影响,应用受试者工作特征曲线(ROC)评估PLR和D-D对AIS的预后的预测价值。结果90例动脉硬化性AIS患者中73例预后良好,17例预后不良;预后不良组患者的心房颤动患病率、美国国立卫生研究院卒中量表(NIHSS)评分、PLR和D-D均高于预后良好组患者,差异均有统计学意义(χ^2=7.20,t分别=5.18、9.48、3.53,P均<0.05)。logistic回归分析显示,PLR和D-D是AIS青年患者不良预后的危险因素(OR分别=1.23、1.71,P均<0.05)。PLR和D-D诊断AIS青年患者预后的ROC曲线下面积分别为0.81和0.84;采用PLR和D-D联合诊断的灵敏度和特异度分别为89.21%、80.49%,均高于D-D、PLR单独检测比较,差异均有统计学意义(χ^2分别=7.23、5.12、6.85、4.79,P均<0.05)。结论PLR和D-D可作为预测AIS青年患者预后的预测因子,二者联合使用可以提高预测AIS青年患者预后价值。

Objective To investigate the predictive effect of plasma D-dimer(D-D)and platelet/lymphocyte ratio(PLR)on prognosis in young patients with acute ischemic stroke(AIS).Methods Ninety patients with arteriosclerotic AIS who received intravenous injection of recombinant tissue plasminogen activator were selected and divided into a good prognosis group and a poor prognosis group according to the MRS score 3 months after surgery.PLR and D-D levels were calculated,and the relationship between the two parameters and clinicopathological parameters of AIS young patients was analyzed.Multivariate logistic regression analysis was used to explore the prognostic effect factors of AIS patients,and receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of PLR and D-D for the prognosis of AIS.Results Of 90 AIS patients,73 cases had a good prognosis and 17 cases had a poor prognosis.The atrial fibrillation prevalence,NIHSS score,PLR,and D-D in the poor prognosis group were higher than those in the good prognosis group(χ^2=7.20,t=5.18,9.48,3.53,P<0.05).PLR and D-D were independent risk factors for poor prognosis in young patients with AIS(OR=1.23,1.71,P<0.05).The area under the ROC curve of PLR and D-D for diagnosing the prognosis of young patients with AIS were 0.81 and 0.84,respectively.The sensitivity and specificity of PLR combined with D-D for diagnosing the prognosis of young patients with AIS were 89.21%and 80.49%,which were higher than those of PLR or D-D single detection(χ^2=7.23,5.12,6.85,4.79,P<0.05).Conclusion PLR and D-D can be used as predictors for the prognosis of young patients with AIS,and the combined detection of the two indicators can improve the prognostic value.