急性脑梗死进展发生的相关危险因素分析

Analysis of related risk factors of neurological deterioration in patients with acute cerebral infarction

目的探讨急性脑梗死早期进展发生的相关危险因素。方法回顾性分析2012年月—2013年12月东南大学附属中大医院神经内科收治的急性脑梗死患者446例。神经功能恶化ND）定义为住院72h内任一时刻复评美国国立卫生研究卒中量表（NIHSS）评分较入院基线NIHSS评分增加2分（ND2）或增加4分（ND4）。将患者分为ND2组（n=107）和非ND2组（n：339），或ND4组（n=62）和非ND4组（n=384）。比较不同组间患者的一般人口学、脑血管病危险因素、影像学以及血液学资料的差异。结果446例患者中，107例（24．0％）诊断为ND2，62例（13．9％）诊断为ND4。单因素分析结果显示，ND2患者和非ND2患者问住院时间、年龄、基线NIHSS评分、入院壹线收缩压、责任动脉闭塞以及血液学检查中的白细胞、空腹血糖和C反应蛋白水平差异均有统计学意义（均P〈0．05）；ND4患者和非ND4患者间性别、年龄、心房颤动、基线NIHSS评分、入院基线女缩压、责任动脉闭塞以及血液C反应蛋白水平的差异均有统计学意义（均P〈0．05）。校正混杂因幕后，Logistic回归分析结果显示，基线NIHSS评分（OR=1.114，95％CI：1．0481～1．185，P=0．001）、C反应蛋白（OR=1．014，95％CI：1．004～1．024，P=0．004）、责任动脉闭塞（OR=2．303，95％CI：1．152～4．606，P=0．018）与ND2独立相关；而年龄（OR=1．040，95％C1：1．011～1．070，。0．006）、收缩压（OR=1．015，95％CI：1．003—1．027，P=0．018）、C反应蛋白（OR=1．016，95％CI：．005～1．026，P=0．003）、责任动脉闭塞（OR=2．845，95％CI：1．291～2．269，P=0．009）与ND4独立旧关。结论急性脑梗死患者早期发生ND与患者年龄、卒中严重程度、基线收缩压、C反应蛋与以及责任动脉闭塞关系密切。临床诊治中，及时完善上述指标的检测有助于鉴别出早期易于进垦恶化的急性脑梗死患者。

Objective To investigate the related risk factors of neurological deterioration （ND） in patients with acute cerebral infarction. Methods A total of 446 patients with acute cerebral infarction admitted to the Department of Neurology, Zhongda Hospital, Southeast University from January 2012 to December 2013 were analyzed retrospectively. ND was defined as the reevaluation of the National Institutes of Health Stroke Scale （NIHSS） scores at any time for the increased admission baseline score 2 （ND2） or 4 （ND4） within the first 72 hours. All subjects were divided into a ND2 group （n=107） andanon-ND2 group （n=339） or a ND4 group （n=62） and a non-ND4 group （n = 384 ）. The differences of general demography, vascular risk factors, imaging, and hematological data among the different groups were compared. Results Of the 446 patients, 107 cases （24.0%） were diagnosed as ND2 and 62 cases （ 13. 9% ） were diagnosed as ND4. The result of univariate analysis showed that there were significant differences in the length of hospital stay, age, baseline NIHSS score, baseline systolic blood pressure on admission, guilty artery occlusion, and the levels of leukocyte,fasting glucose,and C-reactive protein between the ND2 patients and the non-ND2 patients （ all P 〈 0.05 ）. There were significant differences in sex, age, atrial fibrillation, baseline NIHSS score, baseline systolic blood pressure on admission, guilty artery occlusion, and the level of C-reactive protein between the NIM patients and the non-NlM patients （all P 〈 0. 05）. After adjustment for the confounding factors, the results of Logistic regression analysis showed that the baseline NIHSS score （OR,1.114, 95 % CI 1. 0481 - 1.185, P = 0.001 ）, C-reactive protein （ OR, 1.014,95 % CI 1. 004 - 1. 024, P = 0. 004 ）, and guilty artery occlusion （ 0R,2. 303,95% CI 1. 152 -4. 606,P = 0. 018） were independently correlated with ND2 ;while the age （ OR, 1. 040,95 % CI 1. 011 - 1. 070, P = 0. 006 ）, systolic blood pressure （ OR, 1.015,95 % CI 1. 003 - 1. 027, P = 0.018 ）, C-reactive protein （ OR, 1.016,95 % CI 1. 005 - 1. 026, P = 0. 003 ）, and guilty artery occlusion （ OR, 2. 845,95% CI 1. 291 -2. 269, P = 0. 009 ） were independently correlated with ND4. Conclusion The early onset of ND in patients with acute cerebral infarction are closely associated with age, stroke severity, baseline systolic blood pressure, C-reactive protein, and occlusion of guilty artery. In the clinical diagnosis and treatment, detecting the above indicators timely may contribute to identify the patients with acute cerebral infarction and early progressive deterioration.