轻型缺血性卒中早期神经功能恶化的基线预测因素

The baseline predictive factors of early neurological deterioration among mild ischemic stroke patients

目的 明确轻型缺血性卒中早期神经功能恶化（END）的发生率及基线预测因素。方法 连续入选发病72 h内入院的急性轻型缺血性卒中患者。采用单变量分析和多变量Logistic回归分析对基线人口学资料、缺血性卒中危险因素、临床资料、实验室资料及影像学资料进行分析,明确轻型缺血性卒中END的危险因素。结果 从2012年6月~2013年8月共有319例患者入组并纳入分析,其中45例（14.1%）患者发生END。单变量分析显示,END组的基线NIHSS（U=3522.000,P=0.000）、基线收缩压（t=2.871,P=0.004）、症状性颅内外大血管重度狭窄或闭塞患者所占的比例（χ2=52.564,P=0.000）、大动脉粥样硬化型病因分型所占的比例（χ2=47.287,P=0.000）显著高于无END组。多变量Logistic回归分析显示,基线收缩压〉142mm Hg（1 mm Hg=0.133 k Pa）（OR=3.954,95%CI：1.693~9.236,P=0.001）、症状性颅内外动脉重度狭窄或闭塞（OR=3.170,95%CI：1.170~8.583,P=0.023）、基线NIHSS较高（OR=2.038,95%CI：1.359~3.057,P=0.001）与END显著相关。结论 约14.1%的轻型缺血性卒中患者可发生END。基线收缩压〉142 mm Hg、症状性颅内外大血管重度狭窄或闭塞、基线NIHSS较高是轻型缺血性卒中END的独立危险因素。

Objective To determine the occurrence and baseline predictive factors of early neurological deterioration（ END） among mild ischemic stroke patients. Methods Mild ischemic stroke patients admitted in the hospital were prospectively enrolled. Univariate and multivariate Logistic recession analyses were used to analyze the demographic data,risk factors of ischemic stroke,clinical,brain imaging and laboratory data. Risk factors of END were identified. Results From June 2012 to August 2013,a total of 319 patients with mild ischemic stroke were enrolled,45 patients（ 14. 1%） of them experienced END. Univariate analysis showed that baseline NIHSS（ U =3522. 000,P = 0. 000）,baseline systolic blood pressure（ t = 2. 871,P = 0. 004）,proportion of symptomatic large artery severe stenosis or occlusion（ χ2= 52. 564,P = 0. 000） and proportion of large artery atherosclerosis among TOAST subtypes（ χ2= 47. 287,P = 0. 000） in END group were significantly higher than those in non-END group.Multivariate logistic regression analysis showed that baseline systolic blood pressure 142 mm Hg（ 1 mm Hg = 0. 133 k Pa）（ OR = 3. 954,95% CI： 1. 693- 9. 236,P = 0. 001）,symptomatic large artery severe stenosis or occlusion（ OR = 3. 170,95% CI： 1. 170- 8. 583,P = 0. 023） and baseline NIHSS（ OR = 2. 038,95% CI： 1. 359- 3. 057,P = 0. 001） were associated with END. Conclusions About 14. 1% of the mild ischemic stroke patients can occur END. Baseline systolic blood pressure 142 mm Hg,symptomatic large artery severe stenosis or occlusion and higher baseline NIHSS were the independent risk factors of END.