平均血小板体积和脑白质高信号对穿支动脉疾病型脑梗死早期神经功能恶化的预测价值

Predictive value of mean platelet volume and white matter hyperintensity for early neurological deterioration in penetrating artery disease type cerebral infarction

目的探讨平均血小板体积(MPV)和脑白质高信号(WMH)与穿支动脉疾病(PAD)型脑梗死患者早期神经功能恶化(END)的相关性。方法回顾性连续纳入2021年1月至2023年9月苏州市独墅湖医院神经内科收治的经头部MRI等检查诊断的PAD型脑梗死患者,按照入院后7 d内是否发生END分为END组和非END组。收集两组患者的人口学资料、临床资料,包括性别、年龄、体质量指数、高血压病、糖尿病、高脂血症、吸烟、早期(发病7 d内)是否合并肺部感染、入院美国国立卫生研究院卒中量表(NIHSS)评分、入院时收缩压、脑梗死部位(前、后循环供血区)及抗血小板聚集药物治疗方案(单抗、双抗)、白细胞计数、中性粒细胞/淋巴细胞比值、C反应蛋白、血小板计数、血小板压积、MPV、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、同型半胱氨酸、糖化血红蛋白、D-二聚体及纤维蛋白原。根据头部MRI影像,按照改良Fazekas分级,将两组患者的WMH严重程度分为轻度负荷(改良Fazekas分级0~1级)和重度负荷(改良Fazekas分级2~3级)。采用单因素及多因素二元Logistic回归分析MPV和WMH程度与PAD型脑梗死患者发生END的相关性。结果共167例患者纳入本研究,其中END组40例,非END组127例,END发生率24.0%。单因素分析结果显示,END组患者的入院NIHSS评分、糖尿病、MPV以及WMH负荷程度均高于非END组,而血小板计数低于非END组(均P<0.05)。多因素Logistic回归分析显示,MPV和重度负荷WMH是PAD型脑梗死患者发生END的独立影响因素(OR值分别为1.460、2.549,95%CI值分别为1.066~2.000、1.161~5.595,P值分别为0.018、0.020)。受试者工作特征曲线显示,MPV水平及重度负荷WMH程度对PAD型脑梗死患者发生END均有预测价值,曲线下面积分别为0.704(95%CI:0.615~0.793,P=0.001)、0.616(95%CI:0.516~0.716,P=0.028)。结论MPV水平升高和重度负荷WMH是PAD型脑梗死患者发生END的独立影响因素,且MPV的预测价值较重度负荷WMH更高。

Objective To investigate the correlation between mean platelet volume(MPV)and white matter hyperintensity(WMH)with early neurological deterioration(END)in patients with penetrating artery disease(PAD)type cerebral infarction.Methods Patients diagnosed with PAD type cerebral infarction through cranial MRI and other diagnostic examinations were retrospectively enrolled from January 2021 to September 2023 in Department of Neurology in Suzhou Dushu Lake Hospital.These patients were divided into END and non-END groups based on whether END occurred within 7 days after admission.Demographic and clinical data were collected for both groups,including gender,age,body mass index,history of hypertension,diabetes,hyperlipemia,smoking history,early(7 days after onset)pulmonary infection,admission National Institute of Health stroke scale(NIHSS)score,admission systolic blood pressure,site of cerebral infarction(anterior and posterior circulation areas)and antiplatelet drug treatment regimen(mono-and dual antiplatelet),white blood cell count,neutrophil to lymphocyte ratio,C-reactive protein,platelet count,platelet pressure,and MPV,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,blood uric acid,homocysteine,glycosylated hemoglobin,D-dimer and fibrinogen.According to cranial MRI images,patients in both groups were categorized into mild burden WMH(modified Fazekas 0-1 grade)and severe burden WMH(modified Fazekas 2-3 grade)subgroups based on the modified Fazekas scale.Univariate analysis and multivariate binary Logistic regression analysis were applied to assess the correlation between MPV and WMH with END in patients with PAD type cerebral infarction.Results The study included 167 patients with 40 cases in the END group and 127 cases in the non-END group,resulting in an END incidence rate of 24.0%.Univariate analysis revealed that patients in the END group had higher admission NIHSS scores,a higher prevalence of diabetes,elevated MPV levels,and more severe WMH compared to the non-END group,while platelet count was lower in the END group(all P<0.05).Multivariate Logistic regression analysis showed that both MPV and the severe WMH were independent influencing factors for END in patients with PAD type cerebral infarction(OR,1.460,95%CI 1.066-2.000,P=0.018;OR,2.549,95%CI 1.161-5.595,P=0.020).Receiver operating characteristic(ROC)curves demonstrated that both MPV and WMH had predictive value for END in PAD type cerebral infarction patients,with respective areas under the curve values of 0.704(95%CI 0.615-0.793,P=0.001)and 0.616(95%CI 0.516-0.716,P=0.028).Conclusion Elevated MPV levels and increased severity of WMH are independent influencing factors for END in patients with PAD type cerebral infarction,and MPV has a relatively higher predictive value than WMH.