高龄急性缺血性卒中患者预后及其影响因素

Acute ischemic stroke in the very elderly outcome and predictive factors

目的 探讨高龄急性缺血性卒中患者3个月预后及其影响因素。方法 305例年龄≥65岁急性缺血性卒中住院患者纳入研究。依据年龄将患者分为：高龄组78例（≥80岁）和老年组227例（65-79岁）。卒中后（90±7）d 随访功能预后。结果 高龄组比老年组患者3个月预后更差，两组预后不良患者［改良Rankin量表（mRS）=3-6分］ 比例为56.41% 比 41.40%（P=0.015）。Logistic回归分析显示白蛋白（OR 0.73，95% CI 0.55-0.95）、入院时美国国立卫生院神经功能缺损评分（NIHSS）（OR 1.48，95% CI 1.19-1.83）是高龄患者预后不良的影响因素。结论 ≥80岁急性缺血性卒中患者3个月功能预后更差。入院NIHSS高、白蛋白水平低是高龄组缺血性卒中患者3个月功能预后不良的预测因素。

Objective To investigate the clinical characteristics,3-month outcome and predictive factors in the very elderly patients with ischemic stroke. Methods A total of 305 acute ischemic patients aged 65 years and over were enrolled in the study. They were divided into two subgroups by age：80 years old and over（n=78）, 65-79 years old（n=227）. The clinical outcome was assessed by the modified Rankin Scale （mRS） on （90±7） days after stroke , and categorized as good （scoring 0-2）or poor（scoring 3-6） outcome. Results Significantly lower BMI [（23.62±4.92） kg/m2 vs （25.08±3.69） kg/m2,P=0.005], lower frequency of dyslipidemia（56.41% vs 71.13%,P=0.006） and alcohol intake （0% vs 6.61%,P=0.043）were found in the very elderly group. The rates of poor functional outcome in the ≥80 years group and the 65-79 years old group were 56.41% （44/76） and 41.40% （94/224） respectively, with a P value of 0.015. Multivariate logistic regression analysis showed that higher National Institute of Health stroke scale （NIHSS） total score （OR 1.48,95%CI 1.19-1.83） and lower albumin level （OR 0.73, 95%CI 0.55-0.95） were associated with poor outcome in ≥80 year old, whereas higher NIHSS total score （OR 1.38,95%CI 1.24-1.53） and complications during hospital stay （OR 2.58,95%CI 1.07-6.19） were predictive factors in the 65-79 years old group. Conclusion Our study suggests that NIHSS scores, albumin level and complications during hospitalization are useful predictive factors for the short-term poor functional outcome in the patients of ≥65 years old and ≥80 years old patients have a worse prognosis.