血小板微粒对大动脉粥样硬化型脑梗死近期预后的预测价值分析

The value of platelet microparticles in predicting short-term prognosis of patients with cerebral infarction due to large artery atherosclerosis

摘要:

目的 探讨血小板微粒与大动脉粥样硬化型脑梗死患者近期预后的关系及其预测价值。方法 选取2015年7月—2020年11月在青岛市中医医院诊断为大动脉粥样硬化型脑梗死患者152例，均经治疗后好转出院。根据患者出院后30 d的预后情况，分为预后不良组（37例）和预后良好组（115例）。比较两组患者的临床资料、血小板微粒、NIHSS及mRS评分；采用多因素Logistic回归分析预后的影响因素；采用受试者工作特征（ROC）曲线评估血小板微粒对预后的预测效能；绘制Kaplan-Meier曲线，分析血小板微粒与生存时间的关系。结果 预后不良组患者的血小板微粒水平、NIHSS评分及mRS评分高于预后良好组；多因素Logistic回归分析结果显示，血小板微粒［O^R=2.204（95% CI：1.547，3.128）］、NIHSS评分［O^R=1.784（95% CI：1.295，2.436）］及mRS评分［O^R=1.133（95% CI：1.057，1.206）］与预后不良有关（P <0.05）；ROC曲线分析结果显示，血小板微粒预测预后不良的曲线下面积为0.854（95% CI：0.792，0.906），敏感性为0.89（95% CI：0.71，0.95），特异性为0.77（95% CI：0.63，0.84）；Kaplan-Meier生存曲线显示，血小板微粒≥ 中位数组无不良事件生存时间短于血小板微粒< 中位数组。结论 血小板微粒是潜在的判断大动脉粥样硬化型脑梗死患者预后不良的指标，也是该类患者预后不佳的危险因素。

Abstract:

Objective To investigate the value of platelet microparticles in predicting short-term prognosis of patients with cerebral infarction due to large artery atherosclerosis.Methods 152 patients with cerebral infarction due to large artery atherosclerosis in Qingdao Traditional Chinese Medicine Hospital from July 2015 to November 2020 were enrolled in this study, and all of them were discharged with improved conditions after treatment. According to the prognosis of patients 30 days after discharge, they were divided into the poor prognosis group (n = 37) and the good prognosis group (n = 115). Clinical characteristics, platelet microparticles, and National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores were compared between the two groups. The multivariable Logistic regression analysis was performed to determine prognostic indicators. The receiver operating characteristic (ROC) curve was used to assess the value of platelet microparticles for predicting the prognosis, while Kaplan-Meier survival analysis was performed to investigate the relationship between platelet microparticles and the prognosis.Results The levels of platelet microparticles, NIHSS scores and mRS scores of patients with poor prognosis were significantly higher than those of patients with good prognosis. Multivariable Logistic regression analysis found that platelet microparticles [O^R = 2.204 (95% CI: 1.547, 3.128) ], NIHSS scores [O^R = 1.784 (95% CI: 1.295, 2.436) ] and mRS scores [O^R = 1.133 (95% CI: 1.057, 1.206) ] were associated with poor prognosis (P < 0.05). As demonstrated by ROC curve analysis, the area under the ROC curve (AUC) of platelet microparticles for predicting the poor prognosis was 0.854 (95% CI: 0.792, 0.906), with the sensitivity being 0.89 (95% CI: 0.71, 0.95) and the specificity being 0.77 (95% CI: 0.63, 0.84). Kaplan-Meier survival analysis showed that event-free survival time was shorter in patients with the level of platelet microparticles above the median.Conclusions Platelet microparticles are a potential clinical indicator, as well as a risk factor, of poor prognosis in patients with cerebral infarction due to large artery atherosclerosis.