病灶侧别对急性缺血性卒中患者转归的影响

Effect of the side of cerebral lesion on the outcome in patients with acute ischemic stroke

目的探讨脑梗死病灶侧别对缺血性卒中患者转归的影响。方法前瞻性连续纳入发病14d内的前循环缺血性卒中患者，收集病例基本资料，如人口统计学资料、血管危险因素、临床表现、影像学资料、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分和治疗措施等。采用6个月时改良Rankin量表（modified Rankin Scale，mRS）评价患者转归。结果共纳入407例患者，左侧半球卒中230例（56．5％），右侧半球卒中177例（43．5％）；转归良好（mRS评分〈3分）318例，转归不良（mRS评分≥3分）89例。多变量logistic回归分析显示，年龄[优势比（odds ratio，OR）1．022，95％可信间区（confidence interval，CI）1．001～1．043，P=0．040]、梗死病灶侧别（OR1．999，95％CI1．179～3．389，P=0．010）、发病至人院时间（OR1．006，95％CI1．002～1．010，P=0．007）和NIHSS评分（OR1．147，95％CI1．095～1．203，P=0．000）是前循环缺血性卒中发病后6个月时转归的独立预测因素，右侧半球卒中转归较差。与左侧半球卒中相比，右侧半球卒中患者发病至人院的时间显著延迟（左侧：中位数12h，平均22．72h；右侧：中位数12h，平均39．61h，Z=-2．962，P=0．003）。结论左侧半球卒中发病后6个月时转归优于右侧半球卒中，可能与入院时间延迟有关。

Objective To investigate the effect of the side of cerebral lesion on the outcome in patients with ischemic stroke. Methods A total of 407 consecutive anterior circulation ischemic stroke patients within 14 days after symptom onset were recruited prospectively. The basic data of the cases were collected, such as the National Institutes of Health Stroke Scale （NIHSS） and the side of cerebral lesion. The modified Rankin Scale （mRS） was used to evaluate the prognosis of the patients at 6 months. Results Of the 407 patients recruited, 230 patients （56.5%） were left hemisphere stroke, 177 （43. 5%） were right hemisphere stroke. After multivariable logistic regression analysis, the age （ odds ratio [ OR ] 1. 022, 95% confidence interval[ CI] 1. 001-1. 043, P = 0. 040）, the side of lesion （OR 1. 999, 95% CI 1. 179-3. 389, P =0. 010）, the time from onset to admission （OR 1. 006, 95% CI 1. 002-1. 010, P =0. 007）, and NIHSS （OR 1. 147, 95% CI 1. 095-1. 203; P =0. 000） were the independent risk factors for the outcome of the anterior circulation ischemic stroke at 6 months after onset. The outcome of the right hemisphere stroke was significantly worse than that of the left hemisphere stroke. The onset-admission time in patients with right hemisphere stroke （median 12 h, median 39. 61 h）was significantly delayed compared to the patients with left hemisphere stroke （median 12 h, median 22. 72 h; Z = -2. 962, P = 0. 003）. Conclusions The outcome of the left hemisphere stroke at 6 months after onset is superior to the right hemisphere stroke, and it may be associated with the delayed admission.