急性缺血性脑卒中早期神经功能恶化相关复合危险因素分析

Composite risk factors analysis of early neurological deterioration in acute ischemic stroke

目的发现与急性缺血性脑卒中早期神经功能恶化（END）相关的复合危险因素，提高预测和预防急性缺血性脑卒中END的能力。方法选取自2009年10月至2012年12月青岛市市立医院收治的脑梗死患者558例，其中符合急性缺血性脑卒中END诊断标准的患者107例，符合急性缺血性脑卒中早期神经功能无恶化诊断标准的患者451例。筛选神经功能评分等9类58项相关因素变量，采用关联规则挖掘方法分析各项危险因素及其集合与急性缺血性脑卒中END之间的关联关系。结果关联规则挖掘结果发现．与急性缺血性脑卒中END关联度较高的单项危险因素有2项，二项因素集合有3项、三项因素集合有7项、四项因素集合有15项，复合因素越多,END的概率越高。复合因素的集合多以不同类别的因素变量之间的组合为主，涉及到神经功能评分、感染情况、吞咽困难、个人生活史f吸烟、饮酒）、梗死部位、年龄、电解质、C反应蛋白、同型半胱氨酸等。独立危险因素中除了文献常见报道的，本研究还发现人院时的心率以及发病到住院的时间间隔也与急性缺血性脑卒中END具有较强的关联关系。结论急性缺血性脑卒中END的发生可能是多种因素集合共同作用的结果；预防END时，应综合考虑所有的危险因素，采取多种针对性的措施。

Objective To find out the composite risk factors associated with early neurological deterioration （END） in acute ischemic stroke, to reveal the mechanism of END, and to provide the data base for the early prediction and prevention. Methods Five hundred and fifty-eight patients with cerebral infarction admitted to our hospital from October 2009 to December 2012, were screened. Among them, 107 patients met the diagnostic criteria of END in acute ischemic stroke, 451 patients met the diagnostic standard of early acute ischemic stroke without END. Neurological function scale and other variables included 58 related factors of 9 categories were selected. Association rule mining methods were used to analyze relations between END in acute ischemic stroke and risk factors sets. Results The results of association rule mining discovered that there were 2 individual risk factors, 3 double-factor combinations, 7 triple-factor combinations and 15 four-factor combinations related with END in the early stage of acute ischemic stroke; the more the composite factors, the higher the probability of neurological deterioration; the composite factors were mostly the combination of variables of different categories, involving neurological function scale scores, infection condition, dysphagia, personal life history （smoking and drinking）, infarction location, age, and levels of electrolyte, C reactive protein, and homocysteine. Besides some independent risk factors which had been reported in the literatures, the results of this study found that heart rate and time interval from onset to hospitalization also related with END in early acute ischemic stroke. Conclusion END in acute ischemic stroke may be attributed to the combination effect of variable factors; all risk factors should be considered and a variety of targeted measures should be taken to prevent and treat the patients with END in early acute ischemic stroke.