老年急性脑梗死病人短期预后相关因素的分析

Prognostic factors of short-term outcome in elderly patients with acute cerebral infarction

目的探讨影响老年急性脑梗死病人短期预后的相关因素,并对与预后有显著相关的血清学指标作出受试者工作特征(ROC)曲线,得出最佳临界值。方法前瞻性研究100例发病72 h内入院的老年急性脑梗死病人,入院时采集临床资料,进行神经功能缺损评分(NIHSS)、日常生活能力(BI)评分及改良rankin量表(mRS)评分,第二日清晨测量血压,采集空腹血检测空腹血清B型钠尿肽(BNP)、超敏C反应蛋白、血糖、低密度脂蛋白胆固醇、D-二聚体(D-Dimer)、前白蛋白水平,住院期间完善检查进行低分子肝素ORG 10172治疗急性卒中试验(TOAST)分型。发病30 d时复查NIHSS评分、BI评分及mRS评分,分为预后良好和预后不佳组,进行多因素Logistic回归分析,并对与预后有显著相关的指标作出ROC曲线。结果预后不佳组高龄老年人、女性、既往有冠心病史者、心源性栓塞型病人比例较预后良好组明显升高(P<0.05);入院时NIHSS评分(OR=1.587,95%CI:1.149~2.193)、血清BNP(OR=1.342,95%CI:1.103~1.944)、D-Dimer(OR=1.278,95%CI:1.053~1.742)为预后不佳相关因素。入院时NIHSS评分的最佳临界值为7分,血清BNP的最佳临界值为553 pg/ml,血清D-Dimer的最佳临界值为224 ng/ml。结论入院时NIHSS评分>7分、血清BNP>553 pg/ml、血清D-Dimer>224 ng/ml可以预测老年急性脑梗死病人短期预后不佳。

Objective To investigate the prognostic factors of short-term outcome in old patients with acute cerebral infarction,and to draw receiver operating characteristic（ROC） curves for serum indexes which were significantly related to unfavourable prognosis.Methods A hundred consecutive elderly patients with acute cerebral infarction within 72 hours of onset were enrolled in this study.On admission,The clinic data were recorded,and the scores of National Institue of Health Stroke Scale（NIHSS）,Barthel Index（BI） and Modified Rankin Scale（mRS） were assessed.The levels of blood pressure,fasting serum brain natriuretic peptide（BNP）,hypersensitive C-reactive protein（hs-CRP）,blood glucose（GLU）,low density lipoprotein cholesterol（LDL-C）,D-Dimer and prealbumin（PA） were detected in the second morning.30 days after onset,the patients were divided into favourable prognosis group and unfavourable prognosis group according to NIHSS,BI and mRS scores.Multivariate Logistic regression analysis was performed and ROC curves for serum indexes which significant related to unfavourable prognosis were drawn.Results NIHSS score（OR=1.587,95% CI：1.149-2.193）,serum BNP（OR=1.342,95% CI：1.103-1.944）,D-Dimer（OR=1.278,95% CI：1.053-1.742） on admission were related factors of poor outcome.The cut-off value of NIHSS score,serum BNP,D-Dimer on admission is 7 points,553 pg/ml and 224 ng/ml.Conclusions NIHSS score on admission more than 7 points,serum level of BNP more than 553 pg/ml and level of D-Dimer more than 224 ng/ml may predict an unfavourable prognosis of elderly patients with acute cerebral infarction.