目的 研究脑梗死患者抗血小板治疗前后血小板计数(PLT)、血小板平均体积(MPV)及血小板分布宽度(PDW)参数与短期预后的关系。方法 选取2021年1月-2022年12月期间通许第一医院神经内科一病区、二病区、三病区及脑血管科抗血小板治疗的90例脑梗死患者作为研究对象,3个月后随访,采用改良Rankin量表(mRS)评估预后情况,根据mRS评分情况将患者分为预后良好组(MPS≤2分)和预后不良组(MPS＞2分)。比较两组患者的基线资料,抗血小板治疗前后PLT、MPV、PDW等血小板参数变化,并进行多因素Logistic回归分析,采用ROC曲线分析血小板参数与脑梗死患者短期预后的关系。结果 随访结果显示,预后良好组74例,预后不良组16例,两组患者基线资料中的年龄、性别、吸烟史、饮酒史、基础疾病类型比较,差异无统计学意义(P＞0.05)；预后不良组治疗后MPV、PDW水平及治疗前后MPV/PLT水平高于预后良好组,差异有统计学意义(P＜0.05)；多因素Logistics回归分析显示,治疗后的MPV水平升高(OR=1.969,95%CI：1.355~2.863)和MPV/PLT水平升高(OR=2.638×10₇^,95%CI：5.867×10₃^~1.187×10₁₁⁾是脑梗死预后不良的危险因素；ROC曲线分析显示,MPV的ROC曲线下面积为0.812(95%CI：0.716~0.887),敏感性75.00%,特异性77.03%；MPV/PLT的ROC曲线下面积为0.908(95%CI：0.828~0.959),敏感性75.00%,特异性93.24%。结论 抗血小板治疗后MPV和MPV/PLT水平升高是脑梗死预后不良的危险因素,并且具有脑梗死患者短期预后的价值。

Objective To study the relationship between platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and short-term prognosis in patients with cerebral infarction before and after antiplatelet therapy. Methods Tongxu First Hospital Department of Neurology and cerebrovascular unit, A total of 90 patients with cerebral infarction undergoing antiplatelet therapy were enrolled as the research objects between January 2021 and December 2022. After 3 months of follow-up, prognosis was evaluated by modified Rankin Scale (mRS). According to mRS scores, they were divided into good prognosis group (≤2 points) and poor prognosis group (>2 points). The baseline data and changes of PLT, MPV and PDW before and after antiplatelet therapy in the two groups were compared. Multivariate Logistic regression analysis was performed, and the relationship between platelet parameters and short-term prognosis was analyzed by ROC curves. Results The follow-up results showed that there were 74 cases in good prognosis group and 16 cases in poor prognosis group. There was no significant difference in age, gender, smoking history, drinking history or types of underlying diseases between the two groups (P>0.05). MPV and PDW after treatment and MPV/PLT before and after treatment in poor prognosis group were higher than those in good prognosis group (P<0.05). Multivariate Logistic regression analysis showed that increased MPV (OR=1.969, 95%CI: 1.355-2.863) and MPV/PLT (OR=2.638×10₇^{, 95%CI: 5.867×10}₃^{-1.187×10₁₁}) after treatment were risk factors of poor prognosis in cerebral infarction. ROC curves analysis showed that area under ROC curve (AUC), sensitivity and specificity of MPV and MPV/PLT were [0.812 (95%CI: 0.716-0.887), 75.00%, 77.03%] and [0.908 (95%CI: 0.828-0.959), 75.00%, 93.24%], respectively. Conclusion Increased MPV and MPV/PLT after antiplatelet therapy are risk factors of poor prognosis in cerebral infarction, which have short-term prognostic value in patients with cerebral infarction.