急性脑梗死患者血小板参数与溶栓后出血风险的相关性研究

Correlation between platelet parameters and bleeding risk after thromboly sis in patients with acute cerebral infarction

目的:分析急性脑梗死(ACI)患者血小板参数与溶栓后出血风险的相关性。方法:以2020年1月至2021年6月期间新疆维吾尔自治区人民医院神经内科收治的接受rt-PA静脉溶栓的189例患者为观察对象。按照溶栓后出血与否分成出血组(32例)及无出血组(157例)。比较两组的各项基线资料以及血小板参数水平,采用多因素Logistic回归分析法明确ACI患者溶栓后出血的相关影响因素。结果:出血组的入院时美国国立卫生研究院脑卒中量表(NIHSS)评分、其中吸烟每年>400支、患有糖尿病、房颤患者的占比均高于无出血组,差异有统计学意义(P<0.05)。两组的性别、年龄、发病部位、发病至溶栓时间、其中饮酒每日>50 g、患有高血压、血脂异常患者的占比相比,差异无统计学意义(P>0.05)。出血组的血小板比积为(0.22±0.06),无出血组的血小板比积为(0.19±0.04);出血组的血小板比积高于无出血组,差异有统计学意义(P<0.05)。两组的血小板计数、平均血小板体积、血小板体积分布宽度及血小板容积相比,差异无统计学意义(P>0.05)。以ACI患者溶栓后出血为因变量,以吸烟、糖尿病、房颤、入院时NIHSS评分以及血小板比积为自变量进行多因素Logistic回归分析发现,糖尿病、房颤、入院时NIHSS评分以及血小板比积均是ACI患者溶栓后出血的影响因素(P<0.05)。结论:血小板参数中的血小板比积与ACI患者溶栓后出血密切相关。此指标可作为预测ACI患者溶栓后出血风险的参考指标之一。

Objective:To analyze the correlation between platelet parameters and the risk of bleeding after thrombolysis in patients with acute cerebral infarction(ACI).Methods:A total of 189 patients who received RT-PA intravenous thrombolysis in the Department of Neurology,Xinjiang Uygur Autonomous Region People’s Hospital from January 2020 to June 2021 were selected as the observation objects.The patients were divided into bleeding group(n=32)and non-bleeding group(n=157)according to whether thrombolysis resulted in bleeding or not.The baseline data and platelet parameters of the two groups were compared,and multivariate Logistic regression analysis was used to identify the related influencing factors of bleeding after thrombolysis in ACI patients.Results:The National Institutes of Health Stroke Scale(NIHSS)score on admission,the proportion of patients with smoking>400 cigarettes per year,diabetes mellitus,and atrial fibrillation in the bleeding group were higher than those in the non-bleeding group,and the differences were statistically significant(P<0.05).There were no significant differences in gender,age,location of onset,time from onset to thrombolysis,drinking more than 50 g daily,proportion of patients with hypertension and dyslipidemia between the two groups(P>0.05).The platelet specific volume of the bleeding group was(0.22±0.06),and that of the non-bleeding group was(0.19±0.04).The platelet volume in the bleeding group was higher than that in the non-bleeding group,and the difference was statistically significant(P<0.05).There were no significant differences in platelet count,mean platelet volume,platelet volume distribution width and platelet volume between the two groups(P>0.05).Multivariate Logistic regression analysis with bleeding after thrombolytic therapy in ACI patients as the dependent variable and smoking,diabetes mellitus,atrial fibrillation,NIHSS score on admission and platelet ratio as independent variables showed that diabetes mellitus,atrial fibrillation,NIHSS score on admission and platelet ratio were the influencing factors of bleeding after thrombolytic therapy in ACI patients(P<0.05).Conclusion:Platelet ratio is closely related to bleeding after thrombolytic therapy in patients with ACI.This index can be used as one of the reference indexes to predict the risk of bleeding after thrombolysis in A CI patients.