平均血小板体积和脑白质高信号对穿支动脉疾病型脑梗死早期神经功能恶化的预测价值OACSTPCD

Objective To investigate the correlation between mean platelet volume(MPV)and white matter hyperintensity(WMH)with early neurological deterioration(END)in patients with penetrating artery disease(PAD)type cerebral infarction.Methods Patients diagnosed with PAD type cerebral infarction through cranial MRI and other diagnostic examinations were retrospectively enrolled from January 2021 to September 2023 in Department of Neurology in Suzhou Dushu Lake Hospital.These patients were divided into END and non-END groups based on whether END occurred within 7 days after admission.Demographic and clinical data were collected for both groups,including gender,age,body mass index,history of hypertension,diabetes,hyperlipemia,smoking history,early(7 days after onset)pulmonary infection,admission National Institute of Health stroke scale(NIHSS)score,admission systolic blood pressure,site of cerebral infarction(anterior and posterior circulation areas)and antiplatelet drug treatment regimen(mono-and dual antiplatelet),white blood cell count,neutrophil to lymphocyte ratio,C-reactive protein,platelet count,platelet pressure,and MPV,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,blood uric acid,homocysteine,glycosylated hemoglobin,D-dimer and fibrinogen.According to cranial MRI images,patients in both groups were categorized into mild burden WMH(modified Fazekas 0-1 grade)and severe burden WMH(modified Fazekas 2-3 grade)subgroups based on the modified Fazekas scale.Univariate analysis and multivariate binary Logistic regression analysis were applied to assess the correlation between MPV and WMH with END in patients with PAD type cerebral infarction.Results The study included 167 patients with 40 cases in the END group and 127 cases in the non-END group,resulting in an END incidence rate of 24.0%.Univariate analysis revealed that patients in the END group had higher admission NIHSS scores,a higher prevalence of diabetes,elevated MPV levels,and more severe WMH compared to the non-END group,while platelet count was lower in the END group(all P＜0.05).Multivariate Logistic regression analysis showed that both MPV and the severe WMH were independent influencing factors for END in patients with PAD type cerebral infarction(OR,1.460,95%CI 1.066-2.000,P =0.018;OR,2.549,95%CI 1.161-5.595,P =0.020).Receiver operating characteristic(ROC)curves demonstrated that both MPV and WMH had predictive value for END in PAD type cerebral infarction patients,with respective areas under the curve values of 0.704(95%CI 0.615-0.793,P =0.001)and 0.616(95%CI 0.516-0.716,P =0.028).Conclusion Elevated MPV levels and increased severity of WMH are independent influencing factors for END in patients with PAD type cerebral infarction,and MPV has a relatively higher predictive value than WMH.