平均血小板体积预测静脉溶栓治疗的急性缺血性卒中患者的转归

Mean platelet volume predicts the outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

目的探讨平均血小板体积(mean platelet volume,MPV)与急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后临床转归的相关性。方法回顾性连续纳入2019年7月1日至2020年8月30日期间在合肥市第二人民医院神经内科接受标准剂量阿替普酶静脉溶栓治疗的AIS患者。收集患者的临床、实验室和影像学资料,采用改良Rankin量表评价发病后90 d时的临床转归,>2分定义为转归不良。应用多变量logistic回归模型分析MPV与临床转归的独立相关性。应用受试者工作特征(receiver operating characteristic,ROC)曲线分析MPV对临床转归的预测价值。结果共纳入104例接受静脉溶栓治疗的AIS患者。其中,男性40例(38.5%),女性64例(61.5%),年龄(68.7±12.5)岁。基线中位美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分6分(四分位数间距4~11分),发病至静脉溶栓时间为(128.5±55.9)min。75例(72.1%)转归良好,29例(27.9%)转归不良,无死亡病例。转归不良组基线NIHSS评分、C反应蛋白、MPV、MPV/血小板计数比值以及前循环梗死患者的构成比均显著高于转归良好组(P均<0.05)。多变量logistic回归分析显示,MPV[优势比(odds ratio,OR)1.868,95%置信区间(confidence interval,CI)1.277~2.732;P=0.001]和基线NIHSS评分(OR 1.199,95%CI 1.083~1.328;P<0.001)为转归不良的独立危险因素。ROC曲线分析表明,MPV预测转归不良的曲线下面积为0.714(95%CI 0.606~0.821;P=0.001)。最佳截断值为11.25 fl,预测敏感性和特异性分别为65.5%和70.7%。结论MPV与AIS患者静脉溶栓后临床转归存在显著独立相关性,基线MPV较高对患者转归不良具有一定的预测价值。

Objective To investigate the correlation between mean platelet volume(MPV)and clinical outcome in patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods Consecutive patients with AIS treated with standard dose alteplase intravenous thrombolysis in the Department of Neurology,the Second People's Hospital of Hefei from July 1,2019 to August 30,2020 were enrolled retrospectively.The clinical,laboratory,and imaging data of the patients were collected.The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after onset,and a score of>2 was defined as a poor outcome.Multivariate logistic regression model was used to analyze the independent correlation between MPV and clinical outcome.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of MPV for clinical outcome.Results A total of 104 patients with AIS who received intravenous thrombolytic therapy were included,including 40 males(38.5%),64 females(61.5%),and their age was 68.7±12.5 years.The baseline median National Institutes of Health Stroke Scale(NIHSS)score was 6(interquartile range,4-11),and the time from onset to intravenous thrombolysis was(128.5±55.9)min.Seventy-five patients(72.1%)had a good outcome,29(27.9%)had a poor outcome,and there was no death.The baseline NIHSS score,C-reactive protein,MPV,MPV/platelet count ratio and the proportion of patients with anterior circulation infarction in the poor outcome group were significantly higher than those in the good outcome group(all P<0.05).Multivariate logistic regression analysis showed that MPV(odds ratio[OR]1.868,95%confidence interval[CI]1.277-2.732;P=0.001)and baseline NIHSS score(OR 1.199,95%CI 1.083-1.328;P<0.001)were the independent risk factors for poor outcome.ROC curve analysis showed that the area under the curve for predicting poor outcome was 0.714(95%CI 0.606-0.821;P=0.001).The optimal cut-off value was 11.25 fl,the predictive sensitivity and specificity were 65.5%and 70.5%,respectively.Conclusions There was a significant independent correlation between MPV and the clinical outcome in patients with AIS after intravenous thrombolysis.A higher baseline MPV had a certain predictive value for poor outcome.