后循环缺血性脑卒中患者发病与生存状况影响因素的研究

Study on influence factors of morbidity and survival status in patients with posterior circulation cerebral infarction

目的探讨后循环缺血性脑卒中(PCCI)患者发病与生存状况的影响因素。方法选取2011年8月至2015年10月海南省儋州市人民医院收治的358例缺血性脑卒中患者为研究对象,根据其梗死部位分为PCCI组(156例)和前循环缺血性脑卒中(ACCI)组(202例),然后对PCCI患者根据发病3个月后的Barthel指数分为预后良好组(评分大于或等于60分,105例)和预后不良(评分小于60分,51例)组。比较各组的临床资料,采用多因素Logistic回归探讨PCCI发生及预后的影响因素。结果多因素Logistic回归结果表明短暂性脑缺血发作(TIA)史,糖化血红蛋白(HbA1c)≥8.5%,同型半胱氨酸(Hcy)>15μmol/L是患者发生PCCI的独立危险因素(P<0.05),入院时的美国国立卫生研究院卒中量表(NIHSS)评分大于12分,HbA1c≥8.5%,Hcy>15μmol/L,发病至溶栓时间超过4.5h是PCCI者预后不良的独立危险因素(P<0.05)。结论 HbA1c和Hcy升高均是PCCI患者发病和生存状况的独立影响因素,应对其进行早期溶栓,尽可能改善患者的预后。

Objective To explore the influencing factors of morbidity and survival status in the patients with posterior circu- lation cerebral infarction （PCCI）. Methods A total of 358 patients with ischemic cerebral stroke in the Danzhou Municipal People1 s Hospital from August 2011 to October 2015 were enrolled as the study subjects and divided into the PCCI group（n=156） and an- terior circulation cerebral infarction （ACCI） group（n= 202） according to the infarction location. Then the patients with PCCI were divided into the good prognosis group （score≥60 points, n = 105） and poor prognosis group （ score〈60 points, n = 51） according to the Barthel index at 3 months after onset. The clinical data were compared among different groups,and the multivariate Logistic re- gression analysis was adopted to investigate the influence factors of morbidity and prognosis for PCCI. Results The multivariate Logistic regression analysis results showed that the history of transient isehefiaic attack （TIA）, glycosylated hemoglobin（HbAlc） 8. 5% and homocysteine （Hcy）〉15 μmol/L were the independent risk factors of PCCI occurrence（P〈0.05）, and the National In- stitutes of Health Stroke Scale score≥12 points, HbAlc≥8.5%, Hey〉15 μmol/L,time of onset to thrombolysis〉4.5 h were the independent risk factors of poor prognosis in the patients with PCCI （P〈0.05）. Conclusion The rise of HbAlc and Hcy ate the independent influencing factors of occurrence and survival status of PCCI, so thrombolysis should be performed early for improving the prognosis as far as possible.