急性脑梗死患者贫血与预后的关系

Correlation between anemia and outcome in patients with acute cerebral infarction

目的 探讨急性脑梗死患者贫血与预后的关系.方法 前瞻性收集2010年8月至2013年11月到济南军区总医院神经内科住院的急性脑梗死患者858例,记录其年龄、性别、血肌酐、美国国立卫生研究院卒中量表（NIHSS）评分、血红蛋白、红细胞比积等基线资料,并记录住院期间血红蛋白、红细胞比积.根据国内贫血诊断标准诊断患者入院时有无贫血.在发病后180 d通过电话随访,采用改良Rankin量表（mRS）对其预后进行评价（mRS评分≤2分为预后良好,mRS评分＞2分为预后不良）.用多元Logistic回归分析入院时贫血、入院血红蛋白、入院红细胞比积、血红蛋白最低值、红细胞比积最低值等对预后不良和病死率的影响.结果 入院时血红蛋白降低1 g/dl,预后不良的风险比为1.013（95％ CI 1.001 ～1.024,P=0.027）.入院时贫血（OR=2.417,95％ CI 1.202～4.859,P=0.013）是病死率高的独立预测因子;血红蛋白最低值降低1g/dl,病死的风险比为1.016（95％ CI1.002 ～1.030,P=0.026）;红细胞比积最低值降低1个百分点,病死的风险比为1.047（95％ CI1.003 ～1.093,P=0.037）.结论 入院时血红蛋白是急性脑梗死患者预后不良的独立预测因子.入院时贫血、血红蛋白最低值、红细胞比积最低值是急性脑梗死患者病死率高的独立预测因子.

Objective To investigate the correlation between anemia and outcome in a large cohort of unselected patients with acute cerebral infarction.Methods Consecutive acute cerebral infarction patients who were hospitalized were prospectively recruited from August 2010 to November 2013.Eight hundred and fifty-eight patients were enrolled,and the baseline data including age,sex,National Institute of Health Stroke Scale（NIHSS） scores,type of Oxfordshire Community Stroke Project（OCSP：total anterior circulation infarct,partial anterior circulation infarct,posterior circulation infarct and lacunar infarct）,serum creatinine,initial hemoglobin level,initial hematocrit level,etc,were recorded.Hemoglobin level and hematocrit level during hospitalization were also recorded.Domestic criteria were used to define if the patient had anemia on admission.Recovery was assessed by modified Rankin Scale （mRS） 180 days after stroke by telephone interview （mRS scores ≤ 2 reflected good prognosis,and mRS scores 〉 2 reflected unfavorable prognosis）.The influence on outcome by anemia on admission,initial hemoglobin level,nadir hemoglobin level,nadir hematocrit level was analyzed by multinomial Logistic regression analysis.Results Odds ratio of initial hemoglobin level for poor outcome was 1.013 （95% CI 1.001-1.024,P =0.027） with each decrease in hemoglobin of 1 g/dl.Initial anemia（OR =2.417,95% CI 1.202-4.859,P =0.013） was a independent prognostic factor for mortality;odds ratio of nadir hemoglobin level for mortality was 1.016（95% CI 1.002-1.030,P =0.026） with each decrease in hemoglobin of 1 g/dl;odds ratio of nadir hematocrit level for mortality was 1.047（95% CI 1.003-1.093,P =0.037） with decrease in hematocrit of one percentage point.Conclusions Initial hemoglobin level was a independent prognostic factor for poor outcome in patients with acute cerebral infarction.Anemia on admission,nadir hemoglobin level,nadir hematocrit level were independent prognostic factors for mortality in patients with acute cerebral infarction.