【摘要】 目的探讨阿司匹林抵抗(AR)联合血小板-白细胞聚集体(PLA)检测对急性脑梗死(ACI)患者早期神经功能恶化(END)的预测价值,旨在为早期识别END及临床干预提供参考。方法选取ACI患者197例,均于患者入院当天行AR检测、PLA检测,于入院时以及入院后24、48、72 h采用美国国立卫生研究院卒中量表(NIHSS)评估患者的神经功能情况,记录END发生情况,据此分为END组、非END组。依次对两组的可能相关影响因素进行单因素分析和多因素Logistic回归分析。结果197例ACI患者中,发生END者49例,END发生率为24.87%。根据AR的判定标准,END组AR 23例、阿司匹林半抵抗(ASR)15例、阿司匹林敏感(AS)11例,非END组AR 17例、ASR 29例、AS 102例。经单因素分析,END组AR、ASR及PLA、血小板粒细胞聚集体(PNA)、血小板单核细胞聚集体(PMA)、血小板淋巴细胞聚集体(PLyA)均高于非END组(P<0.05或P<0.01)。多因素Logistic回归分析显示,AR及PLA、PMA、PNA、PLyA均为发生END的独立危险因素,存在AR及PLA、PMA、PNA、PLyA水平越高的患者,发生END的风险越高(P<0.05)。结论AR和血小板活化可能都是ACI患者发生END的重要危险因素,AR联合PLA检测对于预测END的发生可能具有积极的临床意义,据此及时调整抗血小板策略,有望减少END的发生。更多还原

【Abstract】 Objective To explore the predictive value on early neurological deterioration(END) in patients with acute cerebral infarction( ACI) by detection of aspirin resistance( AR)combined with platelet-leukocyte aggregates(PLA), to provide reference for END’s early recognition and clinical intervention. Methods 197 cases with ACI were selected, and were all given AR and PLA detection on admission, nerve function were evaluated by NIHSS on admission and 24, 48, 72 h after admission, the occurrence of END were recorded, and were divided into END group and non-END group. Single factor analysis and multiple factor Logistic regression analysis were analyzed on possible related factors in two groups. Results Among 197 patients with ACI, 49 cases occurred END, and the END rate was 24. 87%. According to GUM’s criteria for AR, there were 23 cases with AR, 15 cases with ASR and 11 cases with AS in END group, and 17 cases with AR, 29 cases with ASR and 102 cases with AS in non-END group. Single factor analysis showed that, rates or level of AR, ASR and PLA,PM A, PNA, PLyA in END group were all higher than those in non-END group( P < 0. 05 or P <0.01). Multivariate Logistic regression analysis showed that, AR and PLA, PMA, PNA, PLyA were all independent risk factors of END. For patients with AR and higher level of PLA, PMA, PNA and PLyA,risk of occurring END were higher(P <0. 05). Conclusion AR and platelet activation are important risk factors for patients with ACI to occur END, and it may has positive clinical significance to predict END by detection of AR and PLA, and it may reduce the incidence of END by timely adjusting anti-platelet strategies according to detection of AR and PLA.更多还原