摘要
目的分析血小板聚集率(platelet aggregation,PAg)、D-二聚体(D-Dimer,D-D)水平对急性缺血性脑卒中(acute ischemic stroke,AIS)患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的预测价值。方法对医院2022年7月—2024年4月收治的133例急性缺血性卒中患者临床资料进行回顾性分析,根据患者是否发生END分为发生END组(21例)和未发生END组(112例),观察两组治疗前、治疗3 d、治疗7 d时PAg、D-D水平;并采用受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)评估PAg、D-D对END的预测效果。结果经单因素方差分析显示,治疗前、治疗3 d、治疗7 d时PAg、D-D水平差异有统计学意义(P<0.05);上述指标治疗前>治疗3 d时>治疗7 d时(P<0.05)。133例患者资料经重复测量方差分析显示,PAg在时点因素、时点交互因素、组别因素中差异有统计学意义(P<0.05);D-D指标在时点因素、组别因素中差异有统计学意义(P<0.05);LSD-t检验显示,发生END患者治疗前、治疗3 d、治疗7 d时PAg、D-D水平明显高于未发生END患者;治疗3 d时、治疗7 d时PAg、D-D水平明显低于治疗前;治疗7 d时明显低于治疗3 d时(P<0.05)。经ROC曲线分析显示,PAg、D-D及两项联合预测的曲线下面积(AUC)分别为0.844、0.905、0.947;预测灵敏度、特异度分别为81.0%、85.7%、81.0%及92.9%、90.5%、93.7%;对三种预测方式的AUC差异进行分析发现,PAg与两项联合的AUC差异有统计学意义(P<0.05)。结论PAg、D-D水平对预测AIS患者静脉溶栓治疗后END的发生具有一定的价值与意义,但为避免单一指标的局限性,建议临床中结合其他指标进行综合判定。
Objective To analyze the predictive value of platelet aggregation rate(PAg)and D-dimer(D-D)levels for early neurological deterioration(END)after intravenous thrombolysis in the patients with acute ischemic stroke(AIS).Methods A retrospective analysis was conducted on the clinical data of 133 patients with acute ischemic stroke admitted to the hospital from July 2022 to April 2024.The levels of PAg and D-D were observed before treatment,at 3 days and 7 days after treatment.According to whether END occurred,the patients were divided into the END-occurred group(21 cases)and the END-non-occurred group(112 cases),and the levels of PAg and D-D in the two groups at different time points were observed.The receiver operator characteristic curve(ROC curve)was used to evaluate the predictive effect of PAg and D-D on END.Results One-way ANOVA showed that there were significant differences in the levels of PAg and D-D before treatment,at 3 days and 7 days after treatment(P<0.05),and the levels were in the order of before treatment>3 days after treatment>7 days after treatment(P<0.05).Repeated-measures ANOVA of the data of 133 patients showed that PAg had significant differences in time-point factor,time-point interaction factor and group factor(P<0.05);D-D index had significant differences in time-point factor and group factor(P<0.05).LSD-t test showed that the levels of PAg and D-D in the patients with END before treatment,at 3 days and 7 days after treatment were significantly higher than those in the patients without END;the levels of PAg and D-D at 3 days and 7 days after treatment were significantly lower than those before treatment,and the levels at 7 days after treatment were significantly lower than those at 3 days after treatment(P<0.05).ROC curve analysis showed that the areas under the curve(AUC)of PAg,D-D and their combination for prediction were 0.844,0.905 and 0.947 respectively;the sensitivity and specificity of prediction were 81.0%,85.7%,81.0%and 92.9%,90.5%,93.7%respectively.Analysis of the differences in AUC among the three prediction methods showed that there was a significant difference in AUC between PAg and the combination of the two(P<0.05).Conclusion The levels of PAg and D-D may have certain value and significance in predicting the occurrence of END after intravenous thrombolysis treatment in AIS patients.However,to avoid the limitations of single indicators,it is recommended to make comprehensive judgments by combining with other indicators in clinical practice.
作者
韩志莹
吴海华
HAN Zhiying;WU Haihua(Department of Laboratory,Xuzhou Central Hospital,Xuzhou,Jiangsu,221000,China)
出处
《临床血液学杂志》
2025年第8期593-597,共5页
Journal of Clinical Hematology
关键词
血小板聚集率
D-二聚体
急性缺血性脑卒中
静脉溶栓
神经功能恶化
platelet aggregation rate
D-dimer
acute ischemic stroke
intravenous thrombolysis
neurological deterioration
