缺血性脑血管病患者血小板高反应性与脑梗死分型及预后的关系

The relationship between platelet hyperresponsiveness and cerebral infarction classification and prognosis in patients with ischemic cerebrovascular disease

目的探讨缺血性脑血管病患者血小板高反应性与脑梗死分型及预后的关系。方法选择2019-07—2020-12在上海中医药大学附属龙华医院神经内科住院治疗的220例脑梗死患者为研究对象,根据OCSP分型标准将220例患者分为TACI(n=54)、PACI(n=60)、POCI(n=32)和LACI(n=74)4种亚型,对比各亚型患者的基础资料及实验室指标,对比不同分型患者血小板表达水平及NIHSS评分,通过Spearman法分析患者的OCSP分型与血小板水平的相关性。采用Logistic回归法分析影响脑梗死患者OCSP分型的因素,根据多因素分析结果建立模型,并对预测模型进行评价。对患者随访半年,探讨血小板高反应性对患者的预后影响。结果分型各组患者在收缩压、TC、Hcy、梗死体积、高血压史、脑血管狭窄程度等方面差异有统计学意义(P<0.05),TACI型患者中血小板高反应性的发生率显著高于其他3种亚型(P<0.05)。NIHSS评分随着血小板水平的升高呈逐渐上升趋势,TACI型患者的血小板水平在4种亚型中最高,为(361.67±23.52)×10^(9)个/L;PACI型患者血小板水平在4种亚型中最低,为(314.27±10.14)×10^(9)个/L,差异均有统计学意义(P<0.05)。Spearman相关性分析显示OCSP分型中TACI型与血小板水平呈显著正相关(r=0.683,P<0.05)。Logistic回归分析表明高血压史、Hcy、梗死体积以及血小板高反应性均为脑梗死OCSP分型的独立影响因素,以此建立预测模型。通过绘制ROC曲线对脑梗死OCSP分型预测模型进行评价,预测模型1的AUC为0.806(95%CI0.782~0.814),模型灵敏度为0.725,特异度为0.736。预测模型2的AUC为0.814,预测灵敏度为0.749,特异度为0.764,表示模型具有较好的预测价值。对出院后的患者进行半年随访,血小板高反应性患者的复发、意识障碍以及死亡的风险显著大于血小板水平正常的患者,差异有统计学意义(P<0.05)。结论脑梗死患者血小板水平与其OCSP分型密切相关,对脑梗死患者的治疗及预后具有较好指导意义。

Objective To explore the relationship between platelet hyperresponsiveness and cerebral infarction classification and prognosis in patients with ischemic cerebrovascular disease.Methods The 220 patients with cerebral infarction who were hospitalized in the Department of Neurology of Longhua Hospital,Shanghai University of Traditional Chinese Medicine from July 2019 to December 2020 were selected as the research objects.According to the OCSP classification criteria,220 patients were divided into TACI(n=54)and PACI(n=60),POCI(n=32)and LACI(n=74)four subtypes,compare the basic data and laboratory indicators of patients with each subtype,compare the platelet expression level and NIHSS score of patients with different types,analyze the patients by Spearman method The correlation between OCSP classification and platelet level. Logistic regression method was used to analyze the factors affecting the OCSP classification of patients with cerebral infarction,and the R 3.6.0 software was used to establish a model based on the results of multi-factor analysis,and the prediction model was evaluated. The patients were followed up for half a year to explore the effect of platelet hyperresponsiveness on the prognosis of patients.Results There were statistically significant differences in systolic blood pressure,TC,Hcy,infarct volume,history of hypertension,and degree of cerebrovascular stenosis in each group of patients(P<0.05). The incidence of platelet hyperresponsiveness in TACI patients was significantly higher than the other three subtypes(P<0.05). Logistic regression analysis showed that the history of hypertension,Hcy,infarct volume and high platelet reactivity were all independent influencing factors for the OCSP classification of cerebral infarction. The NIHSS score showed a gradual upward trend with the increase of platelet level. The platelet level of TACI type patients was the highest among the four subtypes,and the platelet level of PACI type patients was the lowest among the four subtypes. The difference was statistically significant(P<0.05). Spearman correlation analysis showed that OCSP classification was significantly positively correlated with serum platelet levels(r=0.683,P<0.05). The patients after discharge from the hospital were followed up for half a year. The risk of recurrence,disturbance of consciousness and death in patients with platelet hyperresponsiveness was significantly greater than that of patients with normal platelet levels,and the gap was statistically significant(P<0.05).Conclusion The platelet level of patients with cerebral infarction is closely related to its OCSP classification,which has a good guiding significance for the treatment and prognosis of patients with cerebral infarction.