高红细胞分布宽度对急性缺血性卒中患者静脉溶栓后早期无改善的预测价值

摘要

Objective To investigate the predictive value of red blood cell distribution width (RDW) for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke received intravenous thrombolysis in the Department of Neurology,the Second Hospital of Tianjin Medical University between January 2017 and December 2018 were enrolled retrospectively.The National Institutes of Health Stroke Scale (NIHSS) score declined ≥4 or the NIHSS score 0-1 in 24 h after thrombolytic therapy was defined as early improvement,and the NIHSS score declined＜4 was defined as no early improvement.Multivariate logistic regression analysis was used to determine the independent risk factors for no early improvement.Receiver operator characteristic (ROC)curve was used to analyze the predictive value of RDW for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.Results A total of 119 patients were enrolled in the study,46 (38.7％) had early improvement and 73 (61.3％) had no early improvement.Hypersensitive C-reactive protein,RDW,the time from onset to thrombolysis,and the proportion of complicated hypertension and fasting blood glucose in the no early improvement group were higher or longer than those in the early improvement group,and the differences were statistically significant (all P ＜0.05).Multivariate logistic regression analysis showed that the elevated RDW was an independent risk factor for no early improvement (odds ratio 3.119,95％ confidence interval 1.584-6.141;P =0.001).ROC curve analysis showed that the best cut-off value of RDW for predicting no early improvement after intravenous thrombolysis in acute ischemic stroke was 13.35％.The area under the curve was 0.737 (95％ confidence interval 0.645-0.828).The sensitivity and specificity were 64.4％ and 87.0％,respectively.Conclusion Elevated RDW has certain predictive value for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.%目的 探讨红细胞分布宽度(red blood cell distribution width,RDW)对急性缺血性卒中患者静脉溶栓后早期无改善的预测价值.方法 回顾性纳入2017年1月至2018年12月期间在天津医科大学第二医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者.溶栓治疗后24 h美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线下降≥4分或NIHSS评分0～1分定义为早期改善,NIHSS评分较基线下降＜4分定义为早期无改善.应用多变量logistic回归分析确定早期无改善的独立危险因素,并采用受试者工作特征(receiver operator characteristic,ROC)曲线分析RDW对急性缺血性卒中患者静脉溶栓后早期无改善的预测价值.结果 共纳入119例患者,早期改善46例(38.7％),早期无改善73例(61.3％).早期无改善组合并高血压的比例以及空腹血糖、超敏C反应蛋白、RDW、发病到溶栓时间均高于或长于早期改善组,差异有统计学意义(P均＜0.05).多变量logistic回归分析显示,RDW较高是早期无改善的独立危险因素(优势比3.119,95％可信区间1.584～6.141;P=0.001).ROC曲线分析显示,RDW预测急性缺血性卒中静脉溶栓后早期无改善的最佳截断值为13.35％,曲线下面积为0.737(95％可信区间0.645～0.828),敏感性和特异性分别为64.4％和87.0％.结论 高RDW对急性缺血性卒中患者静脉溶栓后早期无改善具有一定的预测价值.