天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (3): 291-295.doi: 10.11958/20202510

• 临床研究 • 上一篇    下一篇

平均血小板体积与淋巴细胞比值对静脉溶栓治疗的急性缺血性脑卒中患者预后的预测价值

路洪祥1，杨博峰2，程颖1，孔小祥1△   

  1. 1南京中医药大学连云港附属医院检验科（邮编222002），2神经内科
  • 收稿日期:2020-09-07 修回日期:2021-01-05 出版日期:2021-03-15 发布日期:2021-03-15
  • 通讯作者: 孔小祥 E-mail:tonynanjing@163.com
  • 作者简介:路洪祥（1980），男，本科，副主任技师，主要从事临床检验工作。E-mail：601373127@qq.com

The predictive value of mean platelet volume and lymphocyte ratio in patients with acute ischemic stroke treated with intravenous thrombolysis

LU Hong-xiang1, YANG Bo-feng2, CHENG Ying1, KONG Xiao-xiang1△   

  1. 1 Department of Laboratory Medicine, 2 Department of Neurology, Lianyungang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Lianyungang 222002, China
  • Received:2020-09-07 Revised:2021-01-05 Published:2021-03-15 Online:2021-03-15

PDF (PC)

4519

摘要： 目的　探讨外周血平均血小板体积（MPV）与淋巴细胞比值（MPVLR）对重组组织型纤溶酶原激活剂（rtPA）静脉溶栓治疗的急性缺血性脑卒中（AIS）患者预后的预测价值。方法　收集AIS患者341例，根据发病90 d时改良Rankin量表（mRS）评分，分为预后良好组（mRS＜3分， 198例）和预后不良组（mRS≥3分， 143例）。比较2组患者的临床特征差异，采用多因素Logistic回归分析患者不良预后的影响因素。绘制受检者工作特征（ROC）曲线评价淋巴细胞（LYM）、血小板计数（PLT）、MPV、MPVLR及PLT与淋巴细胞比值（PLR）对AIS患者不良预后的预测价值。结果　（1）预后不良组患者年龄、入院NIHSS评分、MPV、MPVLR、PLR高于预后良好组（均P＜0.05），LYM、PLT低于预后良好组（均P＜0.05）。多因素Logistic回归分析显示年龄（OR=1.026，95%CI：1.004～1.049）、入院NIHSS评分（OR=1.112，95%CI：1.057～1.170）、MPVLR（OR=3.415，95%CI：2.187～5.332）是AIS患者90 d预后的独立影响因素。（2）MPVLR对AIS患者不良预后的预测价值优于LYM、PLT、MPV和PLR，曲线下面积（AUC）分别为0.776、0.676、0.646、0.659、0.703），MPVLR的最佳预测临界值为6.5。以6.5为临界值，高MPVLR组（≥6.5，174例）与低MPVLR组（＜6.5，167例）相比，年龄、入院NIHSS评分、MPV、PLR较高，LYM、PLT较低（均P＜0.05）。结论　外周血MPVLR或可作为rtPA静脉溶栓治疗的AIS患者预后的有效预测指标，有助于对患者进行风险分层，指导个体化治疗。

关键词: 卒中, 血栓溶解疗法, 纤溶酶原激活剂, 预后, 平均血小板体积, 淋巴细胞, 改良Rankin量表, 平均血小板体积淋巴细胞比值

Abstract: Objective　To investigate the predictive value of peripheral blood mean platelet volume and lymphocyte ratio (MPVLR) in the prognosis of acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (rtPA) intravenous thrombolysis. Methods　 A total of 341 patients with AIS were collected. According to the modified Rankin scale (mRS) at 90 days after the onset of AIS, patients were divided into good prognosis group (mRS＜3, n=198) and poor prognosis group (mRS≥3, n=143). The baseline data and laboratory test results were collected in the two groups of patients. The multivariate Logistic regression was used to analyze the factors affecting the poor prognosis of patients. The receiver operating characteristic (ROC) curve was draw to judge and evaluate the prediction threshold of lymphocyte, platelet count (PLT), MPV, MPVLR and PLR for the poor prognosis of AIS patients. Results　(1) The age, NIHSS score，MPV，MPVLR，platelet to lymphocyte ratio (PLR) were significantly higher in the poor prognosis group than those of the good prognosis group (P＜0.05). Data of the lymphocyte count and PLT were significantly lower in the poor prognosis group than those of the good prognosis group (P＜0.05). Multivariate Logistic regression analysis showed that age (OR=1.026, 95%CI: 1.004-1.049), the admission NIHSS score (OR=1.112, 95%CI: 1.057-1.170), MPVLR (OR=3.415, 95%CI: 2.187-5.332) were the independent risk factors for the prognosis of AIS patients at 90 days. (2) ROC analysis showed that MPVLR (0.776) was better for predicting the poor prognosis of AIS than lymphocyte count (0.676), PLT (0.646), MPV (0.659) and PLR (0.703). The best prediction cutoff value of MPVLR was 6.5. With 6.5 as the cutoff value. The age, admission NIHSS score, MPV and PLR were higher in the high MPVLR group (≥6.5, n=174) than those in the low MPVLR group (<6.5, n=167), and the counts of lymphocytes and PLT were lower in high MPVLR group than those of the low MPVLR group (P＜0.05). Conclusion　Peripheral MPVLR might be used as an effective predictor of prognosis in AIS patients treated with rtPA intravenous thrombolysis, which is helpful for risk stratification and individual treatment.

Key words: stroke, thrombolytic therapy, plasminogen activators, prognosis, mean platelet volume, lymphocytes, modified Rankin scale, mean platelet volume to lymphocyte ratio