红细胞分布宽度对急性缺血性卒中患者静脉溶栓预后的预测作用

摘要

目的 探讨红细胞分布宽度(RDW)对急性缺血性卒中(AIS)患者静脉溶栓预后的预测作用. 方法 回顾性分析2014年8月至2017年7月在哈尔滨医科大学附属第一医院神经内科卒中病房连续登记的发病≤4.5 h给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的 AIS患者163例,根据纳入和排除标准,实际有108例患者纳入研究.其中男84例,女24例.根据溶栓后3个月随访时改良Rankin量表(mRS),将患者分为预后良好组(mRS≤2分,79例)和预后不良组(mRS>2分,29例).采集患者的基本资料,包括年龄、性别、既往病史及个人史,于入院24 h内采集静脉血,测定RDW及其他血液学指标.并记录入院时美国国立卫生研究院卒中量表(NIHSS)评分及mRS评分,于患者发病后3个月时采用mRS量表对患者进行预后评分.采用多因素Logistic回归分析方程分析危险因素及受试者工作特征曲线(ROC)分析RDW对患者溶栓结局的预测作用.结果 (1)与预后良好组比较,预后不良组患者入院时NIHSS评分、基线血糖及RDW水平均较高,组间差异均有统计学意义(均P<0.05),其余既往疾病及基线特征组间差异均无统计学意义(均P>0.05).(2)多因素 Logistic回归分析显示,入院时 NIHSS评分(OR =1.209,95% CI:1.094 ~1.337)、基线血糖(OR=1.327,95% CI:1.073~1.641)及RDW(OR=1.701,95% CI:1.030~2.810)增高是AIS患者静脉溶栓后3个月预后不良的独立危险因素(均P<0.05).(3)用于预测3个月预后不良的RDW截值ROC分析,显示曲线下面积为0.651(95% CI:0.530~0.771;P=0.017),RDW最佳预测值为12.2%(敏感度51.7%,特异度77.2%). 结论 RDW是AIS患者rt-PA静脉溶栓后3个月预后的独立预测因子.高水平RDW提示患者神经功能恢复差,预后不良.%Objective To investigate the predictive effect of red blood cell distribution width (RDW) on the prognosis of intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods From August 2014 to July 2017,163 consecutive patients with AIS treated with recombinant tissue type plasminogen activator (rt-PA) intravenous thrombolysis within 4.5 h after onset at the Stroke Unit,Department of Neurology,the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively.According to the inclusion and exclusion criteria,108 patients were included in the study actually.Among them,24 were females and 84 were males.They were divided into either a good prognosis group (n=79,mRS≤2) or a poor prognosis group (n=29,mRS>2) according to the modified Rankin scale(mRS) at 3 months of follow-up after thrombolysis.The basic data of all patients were collected,including age,sex,past medical history,and personal history.Venous blood was collected within 24 h after admission,and RDW and other hematological indexes were measured.The national institutes of health stroke scale (NIHSS)score and mRS score were documented on admission.The mRS was used to conduct prognostic score of the patients at 3 months after the onset.Multiple factor logistic regression model was used to analyze the risk factors and the receiver operating characteristic (ROC) curve was used to analyze the predictive effect of RDW on the thrombolytic outcome of the patients. Results (1) Compared with the good prognosis group,the NIHSS score on admission,baseline blood glucose and RDW levels were higher in patients of the poor prognosis group.There were significant differences between the two groups(all P<0.05).There were no significant differences in other previous diseases and baseline characteristics between the two groups(all P>0.05). (2) Multifactor logistic regression analysis showed that the increased NIHSS score (OR, 1.209,95% CI 1.094-1.337),baseline blood glucose (OR,1.327,95% CI 1.073-1.641),and RDW (OR,1.701,95% CI 1.030-2.810) on admission were the independent risk factors for poor prognosis at 3 months after admission in patients with AIS (all P <0.05). (3) The analysis of RDW cut-off value (ROC) for predicting poor prognosis at 3 months showed that the area under curve (AUC) was 0.651 (95% CI 0.530-0.771;P =0.017),and the best predictive value of RDW was 12.2% (sensitivity 51.7%,specificity 77.2%). Conclusions RDW is an independent predictor of the prognosis of rt-PA intravenous thrombolysis in patients with AIS. High level of RDW indicates that the patients have poor recovery of nerve function,and the prognosis is poor.