合并H型高血压的急性缺血性脑卒中患者重组组织型纤溶酶原激活剂静脉溶栓后血小板平均体积/血小板计数、超敏C反应蛋白/白蛋白比值的变化及对短期预后的评估价值OA

Objective To explore the changing patterns of mean platelet volume/platelet count(MPV/PLT)and high-sensitivity C-reactive protein/albumin(hs-CRP/Alb)ratios after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke(AIS)complicated with H-type hypertension,and to evaluate their value in assessing short-term prognosis.Methods A total of 90 patients with H-type hypertension complicated with AIS who were hospitalized in the Department of Neurology of our hospital from January 2022 to June 2025 were selected.According to the National Institutes of NIHSS score on admission,they were divided into mild group(≤7 points,32 cases),moderate group(8-16 points,38 cases),and severe group(≥17 points,20 cases).Based on the mRS score at 90 d after thrombolysis,they were divided into good prognosis group(0-2 points,72 cases)and poor prognosis group(3-6 points,18 cases).Baseline data of patients were collected,and the levels of MPV,PLT,hs-CRP,and Alb on admission were detected to calculate MPV/PLT and hs-CRP/Alb ratios.Differences in indicators among groups with different disease severities were compared.Univariate and multivariate Logistic regression analyses were used to identify prognostic factors,and ROC curves were drawn to evaluate the predictive efficacy of the indicators for prognosis.Results With the increase of disease severity,the levels of MPV,hs-CRP,and the ratios of MPV/PLT and hs-CRP/Alb gradually increased,while PLT and Alb levels gradually decreased,with statistically significant differences among the three groups(all P<0.001).Univariate analysis showed that the door-to-needle time(DNT)>90 min,NIHSS score,MPV,hs-CRP,MPV/PLT ratio,and hs-CRP/Alb ratio in the poor prognosis group were significantly higher than those in the good prognosis group,while PLT and Alb levels were significantly lower,and the proportion of posterior circulation infarction was significantly higher(all P<0.05).Multivariate Logistic regression analysis revealed that DNT>90 min(OR=1.912,95%CI:1.281-2.543,P=0.027),increased NIHSS score(OR=1.896,95%CI:1.325-2.698,P<0.001),elevated MPV/PLT ratio(OR=2.565,95%CI:1.543-4.265,P<0.001),and increased hs-CRP/Alb ratio(OR=3.124,95%CI:1.876-5.201,P<0.001)were independent risk factors for poor prognosis.ROC curve analysis showed that the AUCs of MPV/PLT ratio,hs-CRP/Alb ratio,and their combination for predicting poor prognosis were 0.845,0.809,and 0.907,respectively,and the combined predictive efficacy was higher than that of a single indicator(P<0.05).Conclusions The MPV/PLT and hs-CRP/Alb ratio of AIS patients with H-type hypertension after thrombolysis showed an increasing trend with the aggravation of the disease and both are independent risk factors for poor short-term prognosis.Combined detection can improve the prognostic predictive efficacy.