大脑中动脉狭窄或闭塞后急性脑梗死梗死灶体积的相关因素分析

Analysis of factors associated with infarct volume in patients with acute ischemic stroke following middle cerebral artery stenosis or occlusion

目的：探讨大脑中动脉狭窄或闭塞后急性脑梗死梗死灶体积的相关影响因素。方法72例大脑中动脉狭窄或闭塞后急性脑梗死患者为研究对象，根据改良 Rankin 量表评分区分患者发病90 d 临床转归好坏，采用受试者工作特征（ROC）曲线拟合出预测90 d 临床转归的梗死灶体积最佳切点水平，并以最佳切点水平分组，分析梗死灶体积的相关影响因素。结果梗死灶体积≤30.92 ml可预测较好的90 d 临床转归，灵敏度为96.0％，特异度为95.7％，ROC 曲线下面积为0.996。梗死灶体积≤30.92 ml 组与体积＞30.92 ml 组的年龄、基线美国国立卫生院神经功能缺损评分、外周血白细胞数、血清白蛋白、超敏 CRP、超氧化物歧化酶、GHbA1c 及脑白质疏松程度，比较差异均有统计学意义（P 均＜0.05）。多因素 Logistic 回归结果显示脑白质疏松程度（OR ＝8.036，95％CI：1.951-44.467，P ＝0.005）及 GHbA1c （OR ＝1.359，95％CI：1.032-4.790，P ＝0.029）是大脑中动脉狭窄或闭塞后急性脑梗死梗死灶体积＞30.92 ml 的危险因素，而白蛋白（OR ＝0.742，95％CI：0.610-0.902，P ＝0.003）是大脑中动脉狭窄或闭塞后急性脑梗死梗死灶体积＞30.92 ml 的保护因素。van Swieten 量表评分3-4级及 GHbA1c≥6.07％的患者梗死灶体积较大（P ＜0.001、P ＝0.001），而白蛋白≥35 g／L 的患者梗死灶体积较小（P ＝0.017）。结论脑白质疏松程度、GHbA1c、血清白蛋白水平可影响大脑中动脉狭窄或闭塞后急性脑梗死梗死灶体积大小。

Objective To analyze the factors associated with infarct volume in patients presenting with acute ischemic stroke after middle cerebral artery stenosis or occlusion.Methods Seventy-two cases with acute ischemic stroke following middle cerebral artery stenosis or occlusion were enrolled in this study.Clinical outcomes at 90 days after onset were evaluated based upon the modified Rankin scale score.The optimal cut-off value of infarct volume at 90-day clinical outcomes was estimated by receiver operating characteristic （ROC） curves.All patients were divided into different groups according to the optimal cut-off value to explore the fac-tors associated with infarct volume.Results The infract volume≤30.92 ml predicted relatively favorable 90-day clinical outcomes with a sensitivity of 96.0%,specificity of 95.7% and ROC area of 0.996.The age, baseline National institute of health stroke scale score,albumin level,high-sensitivity C-reactive protein,su-peroxide dismutase,GHbA1c levels,and leukoaraiosis grade all significantly differed between the infarct volume≤30.92 ml and ＆gt;30.92 ml groups （all P 〈0.05）.Multivariate logistic regression analysis showed that the severity of leukoaraiosis （OR =8.036,95% CI：1.951 -44.467,P =0.005）and GHbA1c （OR =1.359, 95%CI：1.032 -4.790,P =0.029）were independent risk factors,whereas albumin （OR =0.742,95%CI：0.610 -0.902,P =0.003）served as a protective factor for infarct volume greater than 30.92 ml in pa-tients with acute cerebral ischemic stroke after middle cerebral artery stenosis or occlusion.The infarct volume was significantly larger in patients with van Swieten scale score of 3 to 4 or GHbA1c≥ 6.07% （P 〈0.001,P =0.001）,whereas the infarct volume was significantly smaller in those with albumin level ≥ 35g/l （P =0.017）.Conclusion Severity of leukoaraiosis,GHbA1c and albumin level could influence the infarct volume in patients with acute cerebral ischemic stroke following middle cerebral artery stenosis or occlusion.