缺血性脑卒中患者血小板各参数的变化及其临床意义

目的 探讨缺血性脑卒中患者血小板计数（PLT）、血小板平均体积（MPV）及血小板最大聚集率（PAGm）的变化规律及其临床意义。方法 检测168例缺血性脑卒中患者（急性期及恢复期）及40名健康体检者（对照组）PLT、MPV及PAGm，并与神经功能缺损程度进行相关分析。结果 缺血性脑卒中患者急性期MPV及PAGm显著高于其恢复期（P＜0.01）及对照组（P＜0.01），恢复期MPV及PAGm仍高于对照组（P＜0.01）。缺血性脑卒中组急性期患者按牛津郡社区卒中计划（OCSP）分为4个亚型，MPV及PAGm在完全前循环梗死（TACI）组明显高于部分前循环梗死（PACI）组（P＜0.01）、后循环梗死（POCI）组（P＜0.01）及腔隙性梗死（LACI）组（P＜0.01）,PACI组及POCI组明显高于LACI组（P＜0.01），而PACI组与POCI组之间差异无显著性（P＞0.05）。MPV及PAGm与神经功能缺损程度评分呈正相关（r=0.684、0.698,均P＜0.01）。缺血性脑卒中患者PLT在急性期、恢复期与对照组之间均无显著性差异（P＞0.05），TACI组、PACI组、POCI组及LACI组之间差异亦无显著性（P＞0.05）；神经功能缺损程度评分与PLT不存在相关性（r=0.32,P＞0.05）。结论 与PLT相比,MPV及PAGm更能反映缺血性脑卒中的严重程度，可以判断预后，是外周血中较好的血小板参数指标。

The changes and clinical significance of the platelet parameters in patients with ischemic stroke

Objective To study the changes and clinical significance of platelet count,mean platelet volume and maximum platelet aggregation rate in patients with ischemic stroke.Methods One hundred and sixty-eight cases of ischemic stroke(both acute and convalescence) and 40 normal controls were tested for their levels of platelet count,mean platelet volume,maximum platelet aggregation rate and their correlations with neurological functional deficit scale.Results The levels of mean platelet volume and maximum platelet aggregation rate in acute phase in ischemic stroke were markedly higher than those in convalescence((P<)0.01)and in controls((P<)0.01).The levels of mean platelet volume and maximum platelet aggregation rate in convalescence were still higher than those of the controls((P<)0.01).The acute phase of ischemic stroke were divided into four subtypes according to the oxfordshire community stroke project(OCSP),the levels of mean platelet volume and maximum platelet aggregation rate in ischemic stroke were obviously higher in total anterior circulation infarcts(TACI) group than those of partial anterior circulation infarcts(PACI),posterior circulation infacts(POCI) and lacunar infacts(LACI) group((P<)0.01),while PACI and POCI group were markedly higher than LACI group((P<)0.01),but there is no signifcant difference between PACI and POCI group((P>)0.05).The levels of mean platelet volume and maximum platelet aggregation rate were positively related with neurological functional deficit scale(r=0.684 or 0.698,(P<)0.01).No signifcant difference in the platelet count was found in all the groups,the platelet count was not correlated to the neurological functional deficit scale(r=0.32,(P>)0.05).Conclusion Mean platelet volume and maximum platelet aggregation rate are much sensitive to reflect seriousness and predict prognosis of disease,they are good platelet parameter indexes.