抗栓前后血小板参数对非心源性脑梗死预后预测价值研究

Predictive value of platelet parameters before and after antithrombotic treatment for out⁃come of non-cardiogenic cerebral infarction

目的探讨抗栓前及抗栓7 d后血小板计数(PC)、平均血小板体积(MPV)、血小板分布宽度(PDW)及MVP/PC比值和PDW/PC比值在急性非心源性脑梗死(NCCI)中是否具有预测预后的价值。方法纳入2018年12月-2019年7月入住常德市第一人民医院神经内科142例NCCI患者,均在入院第1天抗栓前行PC、MPV、PDW检测。抗栓后第7天,有94例患者完善了PC、MPV、PDW复查。采用改良Rankin量表(MRS)评估患者6个月时神经功能恢复状态,并将其分为预后良好组(MRS≤2分)及预后不良组(MRS>2分),比较上述血小板参数在两组之间的差异。结果不良预后组抗栓前的PC低于预后良好组(P <0.05),而抗栓前MPV/PC、抗栓后MPV、MPV/PC、PDW、PDW/PC高于预后良好组(P <0.05)。多因素Logistics回归分析发现抗栓治疗7 d后的MPV为NCCI不良预后的危险因素(O^R=7.669, 95%CI=1.527~38.528)。ROC曲线提示抗栓后MPV具有预测价值,最佳临界值是10.13fl,曲线下面积(AUC)0.787(P <0.05),灵敏度83.33%,特异度69.50%。结论抗栓治疗7 d后的MPV值为NCCI预后不良的危险因素,对其有预测价值。

Objective To investigate the predictive value for acute non-cardiogenic cerebral infarction(NCCI)outcome of platelet count(PC),mean platelet volume(MPV),platelet distribution width(PDW),MPV/PC ratio,and PDW/PC ratio before and 7 days after antithrombotic treatment.Methods We enrolled 142 patients with NCCI who were hospitalized in the Department of Neurology of the First People’s Hospital of Changde City from December 2018 to July 2019.PC,MPV,and PDW were measured for all the pa⁃tients on the first day of hospitalization before antithrombotic treatment,and were re-measured in 94 patients on the seventh day of anti⁃thrombotic treatment.The Modified Rankin Scale(MRS)was used to evaluate neurological recovery 6 months after disease onset.The patients were divided into good-outcome group(MRS≤2)and poor-outcome group(MRS>2).The platelet parameters were compared between the two groups.Results Compared with the good-outcome group,the poor-outcome group had significantly lower PC before antithrombotic treatment,significantly higher MPV/PC before antithrombotic treatment,and significantly higher MPV,MPV/PC,PDW,and PDW/PC after antithrombotic treatment.Multivariate logistic regression analysis showed that MPV on day 7 of antithrombot⁃ic treatment was a risk factor for a poor outcome of NCCI(odds ratio=7.669,95%confidence interval:1.527-38.528,P<0.05).Ac⁃cording to the receiver operating characteristic curve,MPV had predictive value;the cut-off value was 10.13 fl,and the area under the curve was 0.787(P<0.05),with a sensitivity of 83.33%and a specificity of 69.50%.Conclusions MPV on day 7 of antithrom⁃botic treatment is a predictive risk factor for a poor outcome of NCCI.