红细胞分布宽度与急性缺血性卒中静脉溶栓患者发病严重程度及预后的关系研究

doi:10.3969/j.issn.1673-5765.2020.07.009

摘要/Abstract

摘要：

目的探讨红细胞分布宽度（red blood cell distribution width，RDW）与急性缺血性卒中（acute ischemic stroke，AIS）静脉溶栓患者发病严重程度及预后的关系。方法回顾性分析2016年1月-2019年5月于同济大学附属杨浦医院神经内科接受阿替普酶静脉溶栓治疗的急性缺血性卒中患者的临床资料。将发病后3个月的mRS评分≥2分定义为预后不良。根据 RDW四分位数将患者分为四组，分析RDW与患者入院时NIHSS评分的相关性，多因素Logistic回归分析预后不良的独立影响因素，绘制ROC曲线分析RDW对溶栓患者预后不良的预测价值。结果最终共纳入363例患者，男性232例（63.9%），年龄34～95岁，平均71.15±12.42岁。207 例（57.0%）预后良好，156例（43.0%）预后不良。①RDW与入院时NI HSS评分呈正相关（ρ=0.224， P <0.001）；②多因素Logi sti c回归分析显示既往卒中史（OR 2.257，95%CI 1.302～3.914，P =0.004），入院时NI HSS评分较高（OR 1.145，95%CI 1.084～1.209，P ＜0.001），基线收缩压高（OR 1.015， 95%CI 1.005～1.024，P =0.002），高龄（OR 1.023，95%CI 1.002～1.044，P =0.030）和RDW较高（OR 1.308，95%CI 1.072～1.694，P =0.011）是溶栓患者3个月预后不良的独立危险因素；③RDW预测溶栓患者预后不良的ROC曲线下面积是0.618（95%CI 0.561～0.676，P＜0.001），最佳界值为12.75%，敏感度为65.4%，特异度为55.1%。结论 RDW与AIS溶栓患者入院时的卒中严重程度呈正相关，是3个月预后不良的独立危险因素，对预后具有一定的预测价值。

文章导读： 红细胞分布宽度既与卒中的发病严重程度密切相关，又是溶栓患者3个月预后不良的预测因素。

关键词: 急性缺血性卒中; 静脉溶栓; 红细胞分布宽度; 不良预后; 危险因素

Abstract:

Objective To investigate the correlation between red blood cell distribution width (RDW) and stroke severity and prognosis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis. Methods Data of AIS patients who received alteplase intravenous thrombolysis in Department of Neurology, Yangpu Hospital, Tongji University from January 2016 to May 2019 were retrospectively analyzed. Poor prognosis was defined as a mRS score ≥2 points at 3 months. All the patients were divided into 4 groups according to quartile. The correlation between RDW and NIHSS score at admission was analyzed. Multivariate logistic regression analysis was used to analyze the independent risk factors for poor prognosis. The ROC curve was used to analyze the predictive value of RDW for poor prognosis after intravenous thrombolysis in AIS patients. Results A total of 363 eligible patients were included, with an average age of 71.15±12.42 years (aged 34 to 95 years) and 232 males (63.9%). 207 cases (57.0%) had good prognosis and 156 cases (43.0%) had poor prognosis. RDW was positively correlated with the NIHSS score at admission (ρ =0.224, P <0.001). Multivariate logistic regression analysis showed a history of previous stroke (OR 2.257,95%CI 1.302-3.914, P =0.004), NIHSS score at admission (OR 1.145, 95%CI 1.084-1.209, P <0.001), baseline systolic blood pressure (OR 1.015, 95%CI 1.005-1.024, P =0.002), elder age (OR 1.023, 95%CI 1.002-1.044, P =0.030) and RDW (OR 1.308, 95%CI 1.072-1.694, P =0.011) were independent risk factors for poor prognosis after intravenous thrombolysis in AIS patients. The area under the ROC curve (AUC) of RDW for predicting poor prognosis was 0.618 (95%CI 0.561-0.676, P <0.001), the optimal cut-off value was 12.75%, the sensitivity was 65.4% and the specificity was 55.1%. Conclusions RDW was positively correlated with stroke severity at admission in AIS patients treated with intravenous thrombolysis. RDW was an independent risk factor for poor prognosis at 3 months after thrombolysis in AIS patients.

Key words: Acute ischemic stroke; Intravenous thrombolysis; Red blood cell distribution width; Poor prognosis; Risk factor

李治璋，孔玉明，王佳辉，张东，岳蕴华. 红细胞分布宽度与急性缺血性卒中静脉溶栓患者发病严重程度及预后的关系研究[J]. 中国卒中杂志, 2020, 15(07): 747-752.

LI Zhi-Zhang, KONG Yu-Ming, WANG Jia-Hui,ZHANG Dong, YUE Yun-Hua. Correlation between Red Blood Cell Distribution Width and Stroke Severity and Prognosis of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis[J]. Chinese Journal of Stroke, 2020, 15(07): 747-752.

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