天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (4): 284-288.doi: 10.11958/20191578

• 临床研究 • 上一篇    下一篇

红细胞分布宽度对急性缺血性卒中患者静脉溶栓转归的预测价值 #br#

薛娟娟，路蔚，夏晓爽，李新△
  

  1. 天津医科大学第二医院神经内科（邮编300211）
  • 收稿日期:2019-05-28 修回日期:2019-10-31 出版日期:2020-04-15 发布日期:2020-06-23
  • 通讯作者: 李新 E-mail:jessielx@ 126.com
  • 作者简介:薛娟娟（1989），女，硕士，主治医师，主要从事脑血管病的研究
  • 基金资助:
    天津市自然科学基金（16JCYBJC25500）；天津市教委社会科学重大项目（2017JWZD36）；天津市卫生行业重点攻关项目
    （    15KG136）

Predictive value of red blood cell distribution width for outcome of intravenous#br# thrombolysis in patients with acute ischemic stroke #br#

XUE Juan-juan, LU Wei, XIA Xiao-shuang, LI Xin△ #br#   

  1. Department of Neurology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
  • Received:2019-05-28 Revised:2019-10-31 Published:2020-04-15 Online:2020-06-23
  • Contact: LI Xin E-mail:jessielx@ 126.com

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摘要： 目的 探讨红细胞分布宽度（RDW）对急性缺血性卒中（AIS）患者静脉溶栓转归的预测价值。方法 分析
2017年 1月—2019年 1月期间天津医科大学第二医院神经内科接受静脉溶栓治疗的 122例 AIS患者，溶栓后 3个月
时应用改良 Rankin量表（mRS）评估临床转归，0~2分为转归良好，>2分为转归不良。比较 2组患者临床基线资料及
相关实验室检查指标，应用多变量Logistic回归分析影响转归不良的危险因素，通过绘制受试者工作特征（ROC）曲线
评价 RDW对 AIS患者静脉溶栓转归不良的预测价值。结果 122例患者中转归良好 69例（56.6%），转归不良 53例
（43.4%），转归不良组合并高血压史、卒中史、心脏病史、房颤史的比例以及年龄、入院美国国立卫生研究院卒中量表
（NIHSS）评分、空腹血糖（FBG）、超敏 C反应蛋白（hs-CRP）、尿酸（UA）、RDW值均高于转归良好组（P＜0.05）。多变量 Logistic回归分析显示，高 FBG、入院高 NIHSS评分以及 RDW水平升高是转归不良的危险因素，以 RDW为变量对
转归不良预测效能的 ROC曲线下面积为 0.754（95%CI：0.665~0.843），RDW预测 AIS静脉溶栓转归不良的截断值为
13.15%，敏感度为62.3%，特异度为84.1%。结论 高RDW水平是AIS患者静脉溶栓转归不良的独立危险因素，RDW
对AIS患者静脉溶栓转归有一定的预测价值。

关键词: 卒中, 脑缺血, 血栓溶解疗法, 组织型纤溶酶原激活物, 治疗结果, 危险因素

Abstract: Objective To explore the predictive value of red blood cell distribution width (RDW) for the outcome of
intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods A total of 122 patients with AIS admitted
to the Department of Neurology, the Second Hospital of Tianjin Medical University for the treatment of intravenous
thrombolysis between January 2017 and January 2019 were enrolled retrospectively. Three months after treatment, the
clinical outcome was assessed by the modified Rankin scale (mRS). The score of 0-2 was defined as good outcome, and>2
was defined as poor outcome. Clinical basic data, blood count and biochemical data were compared between the two groups.
Multivariate Logistic regression analysis was used to determine the independent risk factors for poor outcome. Receiver
operator characteristic (ROC) curve was used to analyze the predictive value of RDW for poor outcome after intravenous
thrombolysis in patients with AIS. Results In 122 patients, 69(56.6%) showed good outcome and 53(43.4%) showed poor
outcome. The proportions of hypertension, stroke, heart disease, atrial fibrillation and the values of age, baseline National
Institutes of Health Stroke Scale (NIHSS) score, fasting blood glucose (FBG), high sensitivity C-reactive protein (hs-CRP),
uric acid (UA) and RDW were significantly higher in poor outcome group than those in good outcome group (P＜0.05).
Multivariate Logistic regression analysis showed that high FBG level, high NIHSS score and elevated RDW were the
independent risk predictors of poor outcome after intravenous thrombolysis in patients with AIS. The cutoff RDW value for
predicting poor outcome after intravenous thrombolysis in patients with AIS was more than 13.15% with a sensitivity of
62.3% and a specificity of 84.1% (area under the curve, 0.754; 95% confidence interval 0.665-0.843). Conclusion The
elevated RDW is an independent risk factor for poor outcome after intravenous thrombolysis in patients with AIS. RDW has a certain predictive value for outcome after intravenous thrombolysis in patients with AIS.

Key words: stroke, brain ischemia, thrombolytic therapy, tissue plasminogen activator, treatment outcome, risk factors

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