影响皮质型分水岭梗死病情严重程度的因素研究

Investigation about the influence factors of severity of cortical watershed infarction

目的研究皮质型分水岭梗死病情严重程度的相关影响因素。方法回顾性分析51例皮质型分水岭梗死患者的临床资料，根据美国国家卫生研究所卒中量表（NIHSS）评分将其病情严重程度分为三组：轻度（NIHSS评分≤3分）、中度（NIHSS评分4～14分）和重度（NIHSS评分≥15分）。首先采用单因素分析对可能影响病情严重程度的因素进行分析，然后将与病情严重程度相关的影响因素纳入Logistic回归分析，确定皮质型分水岭梗死患者病情严重程度的独立危险因素。结果单因素分析显示，年龄、糖尿病、侧支循环、脑缺血溶栓血流分级、血浆溶血磷脂酸水平在不同病情严重程度的皮质型分水岭脑梗死患者中存在统计学差异（均P〈0．05）。经Logistic回归分析，年龄（OR=0．314，95％CI：0．120—0．781）、侧支循环（OR=0．197，95％CI：0．049—0．780）、脑缺血溶栓血流分级（OR=0．394，95％CI：0．178—0．838）、血浆溶血磷脂酸水平（OR=0．041，95％CI：0．013—0．133）是影响皮质型分水岭梗死病情严重程度的独立危险因素。结论除年龄外，侧支循环、脑缺血溶栓血流分级、血浆溶血磷脂酸水平能够影响皮质型分水岭梗死的病情严重程度，对上述指标的监测将有助于皮质型分水岭梗死的发病机制探讨和病情评估，进而指导临床治疗。

Objective To investigate the influence factors of severity of cortical watershed infarction. Methods This retrospective study analyzed the clinical data of 50 patients with cortical watershed infarction. According to the National Institute of Health stroke scale （NIHSS） score, severities of the subjects were divided into three groups： mild group （NIHSS score 〈3 points）, moderate group （NIHSS score 4-14 points）, and severe group （NIHSS score 〉15 points）. Univariate analysis was used to analyze the correlated factors of severity of cortical watershed infarction, and then multivariate logistic regression analysis was used to analyze independent risk factors of severity of cortical watershed infarction. Results In univariate analysis, age, diabetes mellitus, collateral circulation, flow grades of thrombolysis in brain ischemia, and lysophosphatidic acid were significantly associated with severity of cortical watershed infarction. In multiple logistic regression, age （OR=0.314, 95%CI： 0.120-0.781）, collateral circulation （OR=0.197, 95%CI： 0.049-0.780）, flow grades of thrombolysis in brain ischemia （OR=0.394, 95%CI： 0.178-0.838）, lysophosphatidic acid （OR=0.041, 95%CI： 0.013-0.133） were independent risk factors of severity of cortical watershed infarction. Conclusions In addition to age, collateral circulation, flow grades of thrombolysis in brain ischemia, and the level of lysophosphatidic acid can affect the severity of cortical watershed infarction. Monitoring above indicators will contribute to exploring the pathogenesis, assessing the condition, to guide the clinical treatment.