红细胞分布宽度对急性缺血性卒中静脉溶栓早期神经功能改善不良的预测作用

doi:10.12092/j.issn.1009-2501.2023.03.009

中国临床药理学与治疗学 ›› 2023, Vol. 28 ›› Issue (3): 307-314.doi: 10.12092/j.issn.1009-2501.2023.03.009

红细胞分布宽度对急性缺血性卒中静脉溶栓早期神经功能改善不良的预测作用

吴志勇1，刘兵荣1，李彬2，汤睿3

1 安徽医科大学临床医学院直属附属德驭医疗马鞍山总医院（原马鞍山市中心医院）神经内科，马鞍山 243000，安徽； 2 安徽省第二人民医院神经内科，合肥 230032，安徽； 3 中国科学技术大学附属第一医院神经重症科，合肥 230036，安徽

收稿日期:2022-12-28 修回日期:2023-01-19 出版日期:2023-03-26 发布日期:2023-04-19
作者简介:吴志勇，男，硕士，副主任医师，研究方向：脑血管病，帕金森病。 E-mail: wzy197809@163.com
基金资助:
国家自然科学基金（81870060）

Value of red blood cell distribution width in predicting early poor neurologic improvement after intravenous thrombolysis in patients with ischemic stroke

WU Zhiyong1, LIU Bingrong1, LI Bin2, TANG Rui3

1 Deparment of Neurology, Ma'anshan General Hospital of Ranger-Duree Healthcare, Driectly Affiliated to Clinical College of Anhui Medical University, Ma'anshan 243000, Anhui, China; 2 Department of Neurology, Anhui NO.2 Provincial People's Hospital, Hefei 230032, Anhui, China; 3 Department of Neurocritical Care Unit, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230036, Anhui, China

Received:2022-12-28 Revised:2023-01-19 Online:2023-03-26 Published:2023-04-19

摘要/Abstract

摘要： 目的：探讨红细胞分布宽度（RDW）对急性缺血性卒中静脉溶栓早期神经功能改善不良的预测价值。方法：回顾性连续纳入发病 4.5 h内行重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓的急性缺血性卒中患者 102例，均于溶栓前检测 RDW。采用 NIHSS评分，将溶栓后 24 h神经功能与溶栓前对比，根据变化百分率分为两组：早期神经功能改善良好组，变化≥30%，共 53例；改善不良组，变化＜30%，共49例。采用单因素及多因素 Logistic回归分析，探究 RDW是否是溶栓后早期神经功能改善独立影响因素，应用受试者工作特征曲线（ROC）评价 RDW对溶栓后早期神经功能改善不良的预测价值。结果：早期神经功能改善不良组与改善良好组相比，房颤（24.5% vs. 9.4%，P=0.042）、糖尿病（57.1% vs. 30.2%，P= 0.006）、出血转化（10.2% vs. 0%，P=0.023）的比例在改善不良组均明显高于改善良好组，RDW水平也显著高于改善良好组［（14.09±0.77）vs.（13.31±0.63），P=0.000］。Logistic回归分析显示既往糖尿病史（OR=2.606，95%CI：1.034-6.573，P= 0.042）、RDW（OR=4.614，95%CI：2.263-9.408，P= 0.000）是早期神经功能改善不良的独立危险因素，ROC曲线显示 RDW预测溶栓后早期神经功能改善不良的临界值为 13.56%（曲线下面积 0.782，95%CI：0.690-0.874，敏感度 76%，特异度 74%）。结论：RDW升高对静脉溶栓后早期神经功能改善不良具有预测价值。

关键词: 红细胞分布宽度, 急性脑梗死, 静脉溶栓, 早期神经功能改善

Abstract:

AIM: To explore the predictive value of red blood cell distribution width (RDW) in early poor neurologic improvement after intravenous thrombolysis in acute ischemic stroke (AIS). METH-ODS: A total of 102 patients with acute ischemic stroke who received intravenous thromblysis with alteplase within 4.5 hours of onset were analyzed retrospectively. RDW level was measured before thrombolysis. According to the percentage change in NIHSS at 24 hours, the patients were divided in-to two groups: good neurological improvement (≥ 30%) group (n=53) and poor neurological improve-ment (<30%) group (n=49). The univariate and mul-tivariate Logistic regression analysis were used to investigate whether RDW level is an independent factor affecting patients' neurological improve-ment. The receiver operating characteristic (ROC) curve was used to analyze the cut-off value of RDW to predict poor early neurological improvement af-ter thrombolysis. RESULTS: Compared with the good neurological improvement group, higher pro-portion of atrial fibrillation (24.5% vs. 9.4%, P=0.042), diabetes mellitus (57.1% vs. 30.2%, P=0.006), hemorrhagic transformation (10.2% vs. 0%, P=0.023) in the poor neurological improvement group. The level of RDW in poor neurological im-provement group was significantly higher than that in good neurological improved group［(14.09±0.77) vs. (13.31±0.63), P=0.000］. Logistic regression anal-ysis showed that elevated RDW (OR=4.614, 95%CI: 2.263-9.408, P=0.000) and history of diabetes melli-tus (OR=2.606, 95%CI: 1.034-6.573, P=0.042) were independently associated with early poor neurolog-ical improvement. The ROC curve analysis showed that the optimal cut-off value of RDW to predict poor early neurological improvement after throm-bolysis was 13.56% (AUC=0.782, 95%CI: 0.690-0.874; sensitivity 76%; specificity 74%). CONCLU-SION: Elevated RDW is of a certain value in predict-ing the poor early neurological improvement of AIS patients after thrombolysis.

Key words: red blood cell distribution width, acute cerebral infarction, intravenous thrombolysis, early neurologic improvement

中图分类号:

R743.32

吴志勇, 刘兵荣, 李彬, 汤睿. 红细胞分布宽度对急性缺血性卒中静脉溶栓早期神经功能改善不良的预测作用[J]. 中国临床药理学与治疗学, 2023, 28(3): 307-314.

WU Zhiyong, LIU Bingrong, LI Bin, TANG Rui. Value of red blood cell distribution width in predicting early poor neurologic improvement after intravenous thrombolysis in patients with ischemic stroke [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2023, 28(3): 307-314.

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红细胞分布宽度对急性缺血性卒中静脉溶栓早期神经功能改善不良的预测作用

Value of red blood cell distribution width in predicting early poor neurologic improvement after intravenous thrombolysis in patients with ischemic stroke

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