Analysis and research of platelet aggregation rate and red blood cell distribution width in diagnosis and treatment of acute cerebral infarction
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摘要: 目的 探讨血小板聚集率(PAgT)、红细胞分布宽度(RDW)在诊治急性脑梗死(ACI)中的临床价值。方法 选取汕头市潮阳区大峰医院2021年10月—2023年3月ACI患者100例(ACI组)，均接受阿替普酶静脉溶栓治疗，根据溶栓效果将患者分为溶栓效果良好(n=65)和溶栓效果不良(n=35)，另选取同期健康体检者100例(正常对照组)。比较2组及不同溶栓效果患者PAgT、RDW，分析ACI患者溶栓效果影响因素及入院时PAgT、RDW单一或联合预测溶栓效果价值。结果 入院时，ACI组PAgT、RDW均高于正常对照组(P < 0.05)；溶栓效果不良患者NIHSS评分高于溶栓效果良好患者，梗死体积大于溶栓效果良好患者(P < 0.05)；入院时及溶栓后24 h，溶栓效果不良患者PAgT、RDW均高于溶栓效果良好患者(P < 0.05)；多因素logistic回归分析发现，梗死体积(OR=2.559，95%CI 1.219~5.374)、NIHSS评分(OR=2.344，95%CI 1.152~4.769)、入院时PAgT(OR=1.414，95%CI 1.096~1.824)、入院时RDW(OR=2.005，95%CI 1.407~2.856)均为ACI患者溶栓效果影响因素(P < 0.05)；入院时PAgT、RDW联合预测溶栓效果的曲线下面积(AUC)最大，为0.964。结论 ACI患者PAgT、RDW明显升高，且高PAgT、RDW是ACI溶栓效果影响因素，联合检测有助于提高预测效能，指导临床治疗。Abstract: Objective To investigate the clinical value of platelet aggregation rate(PAgT) and red blood cell distribution width(RDW) in the diagnosis and treatment of acute cerebral infarction(ACI).Methods A total of 100 patients with ACI(ACI group) in Dafeng Hospital from October 2021 to March 2023 were selected. All patients received intravenous thrombolysis with alteplase. According to the thrombolysis effect, the patients were divided into good thrombolysis effect(n=65) and poor thrombolysis effect(n=35). In addition, 100 healthy subjects(normal control group) were selected. PAgT and RDW were compared between the two groups and patients with different thrombolysis effects. The influencing factors of thrombolysis effect in ACI patients and the value of PAgT and RDW alone or in combination in predicting thrombolysis effect at admission were analyzed.Results On admission, PAgT and RDW in ACI group were higher than those in normal control group(P < 0.05). The NIHSS score of patients with poor thrombolytic effect was higher than that of patients with good thrombolytic effect, and the infarct volume was larger than that of patients with good thrombolytic effect(P < 0.05). At admission and 24 h after thrombolysis, PAgT and RDW in patients with poor thrombolytic effect were higher than those in patients with good thrombolytic effect(P < 0.05). Multivariate logistic regression analysis showed that infarct volume(OR=2.559, 95%CI 1.219-5.374), NIHSS score(OR=2.344, 95%CI 1.152-4.769), PAgT at admission(OR=1.414, 95%CI 1.096-1.824), RDW at admission(OR=2.005, 95%CI 1.407-2.856) were the influencing factors of thrombolytic effect in ACI patients(P < 0.05). At admission, the area under the curve(AUC) of PAgT and RDW combined to predict the effect of thrombolysis was the largest, which was 0.964.Conclusion PAgT and RDW in ACI patients increased significantly, and high PAgT and RDW were the influencing factors of ACI thrombolytic effect. Combined detection could be helpful to improve the predictive efficiency and guide clinical treatment.
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表 1 2组PAgT、RDW比较
%，X±S 组别 例数 PAgT RDW ACI组 100 68.03±6.74 14.04±0.63 正常对照组 100 55.46±5.21 12.42±0.57 t 14.755 19.068 P < 0.001 < 0.001 
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表 2 不同溶栓效果患者一般资料
因素 溶栓效果不良(n=35) 溶栓效果良好(n=65) χ2/t P 性别/例(%) 1.561 0.212 男 17(48.57) 40(61.54) 女 18(51.43) 25(38.46) 年龄/岁 60.37±6.32 58.64±5.96 1.356 0.178 入院至溶栓时间/h 3.02±0.70 2.76±0.62 1.911 0.059 BMI/(kg/m2) 21.50±1.12 21.37±1.07 0.570 0.570 既往史/例(%) 高血压 15(42.86) 24(36.92) 0.337 0.562 糖尿病 7(20.00) 10(15.38) 0.344 0.558 高脂血症 8(22.86) 13(20.00) 0.112 0.738 梗死部位/例(%) 1.366 0.505 前循环梗死 19(54.29) 43(66.15) 后循环梗死 10(28.57) 14(21.54) 前循环+后循环梗死 6(17.14) 8(12.31) 吸烟/例(%) 0.067 0.795 是 10(28.57) 17(26.15) 否 25(71.43) 48(73.85) 饮酒/例(%) 0.129 0.719 是 12(34.29) 20(30.77) 否 23(65.71) 45(69.23) 梗死体积/cm3 6.31±1.04 4.53±0.87 9.105 < 0.001 NIHSS评分/分 14.73±2.21 11.35±2.03 7.698 < 0.001
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表 3 不同溶栓效果患者PAgT、RDW表达
%，X±S 患者 例数 PAgT RDW 入院时 溶栓后24 h 入院时 溶栓后24 h 溶栓效果不良 35 71.56±5.35 69.31±5.11 15.19±0.85 14.18±0.79 溶栓效果良好 65 66.13±4.52 56.63±4.28 13.42±0.77 12.37±0.70 t 5.369 13.191 10.571 11.786 P < 0.001 < 0.001 < 0.001 < 0.001
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表 4 ACI患者溶栓效果影响因素
因素 β SE Wald χ2 OR 95%CI P 梗死体积 0.940 0.249 14.245 2.559 1.219~5.374 < 0.001 NIHSS评分 0.852 0.214 15.844 2.344 1.152~4.769 < 0.001 入院时PAgT 0.346 0.109 10.097 1.414 1.096~1.824 0.001 入院时RDW 0.695 0.137 25.768 2.005 1.407~2.856 < 0.001
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表 5 入院时PAgT、RDW单一及联合预测溶栓效果价值
指标 AUC SE 95%CI P 入院时PAgT 0.796 0.049 0.700~0.892 < 0.001 入院时RDW 0.949 0.024 0.902~0.995 < 0.001 联合 0.964 0.017 0.930~0.997 < 0.001
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