症状性颅内外动脉重度狭窄或闭塞的轻型卒中患者的临床特点及预后

Clinical characteristics and prognosis of mild stroke patients with symptomatic artery severe stenosis or occlusion

目的 探讨症状性颅内外动脉重度狭窄或闭塞的轻型卒中患者的临床特点及预后.方法 288例轻型卒中患者[美国国立卫生研究院卒中量表（NIHSS）评分≤3分]根据脑梗死溶栓（TICI）系统分级,将0～1级定义为症状性动脉重度狭窄或闭塞.采集患者完整的临床资料,于出院时行NIHSS评分、发病90 d时行改良的Rankin量表（mRS）评分.症状首发5d内原有神经功能缺损症状加重、NIHSS评分增加值≥2分为早期神经功能恶化;90 d mRS评分≥3分为预后不良.结果 根据TICI分级,本组中66例患者（22.9％）为症状性动脉重度狭窄或闭塞的轻型卒中患者.与不伴症状性动脉重度狭窄或闭塞组比较,症状性动脉重度狭窄或闭塞组轻型卒中患者入院时NIHSS评分、空腹血糖及大动脉粥样硬化型比例明显增高（P＜0.05～0.01）;早期神经功能恶化、预后不良的比例及出院时NIHSS评分、发病90 d时mRS评分明显增高（均P＜0.01）.多因素Logistic回归分析显示,症状性动脉重度狭窄或闭塞是轻型卒中早期神经功能恶化（OR =7.4,95％ CI：3.4～15.9,P＜0.01）及预后不良（OR=7.8,95％ CI：4.0～15.2,P＜0.01）的独立危险因素.结论 症状性动脉重度狭窄或闭塞的轻型卒中患者发生早期神经功能恶化和预后不良比例较高,不应被视为“轻型卒中”.

Objective To observe the clinical characteristics and prognosis of mild stroke patients with symptomatic artery severe stenosis or occlusion （sASO）.Methods Two hundred and eighty-eight mild stroke patients [national institutes of health stroke scale （NIHSS） ≤3] were degreed by thrombolysis in cerebral infarction （TICI） grading system,and grade 0-1 was defined as sASO.The complete clinical data of patients was collected.The NIHSS was scored before discharge from hospital,and the modified rankin scale （mRS） was scored at 90 d after onset.Rapid deteriorating of existing neurologic deficits with NIHSS increase ≥2 within 5 d since onset was defined as early neurological deterioration.The mRS scores ≥ 3 at 90 d after onset was defined as poor prognosis.Results According to TICI grading system,there were 66 patients （22.9％） with sASO.Compared with non-sASO group,the NIHSS score on admission,fasting plasma glucose and the rate of artery atherosclerosis type were significantly increased （P ＜0.05-0.01）; the rates of early neurological deterioration,poor prognosis and the NIHSS score on discharge,the mRS score at 90 d after onset were significantly increased （all P ＜ 0.01）.Logistic regression analysis showed that sASO was the independent risk factor of early neurological deterioration （OR =7.4,95％ CI：3.4-15.9,P ＜ 0.01） and poor prognosis （OR =7.8,95％ CI：4.0-15.2,P ＜ 0.01） in patient with mild stroke.Conclusion The rates of early neurological deterioration and poor prognosis in mild stroke patients with sASO are increased,they should not be considered as ＂mild stroke＂.