恶性大脑中动脉供血区梗死的危险因素：中青年与老年患者的比较

Risk factors for malignant middle cerebral artery infarction： a comparison of young and middle-aged and elderly patients

目的探讨不同年龄段恶性大脑中动脉供血区梗死（malignant middle cerebral artery infarction, MMI）的危险因素。 方法回顾性分析MCA供血区梗死患者，按年龄分为中青年组（〈60岁）及老年组（≥60岁）。在总体病例以及各年龄组中比较MMI与非MMI患者的人口统计学、血管危险因素、卒中病因学分型、基线血压、发病前药物使用情况以及常见血液化验结果。采用多变量logistic回归分析确定MMI的独立危险因素。 结果共纳入912例MCA供血区梗死患者，其中男性613例（67.21%），女性299例（32.79%）；中青年患者401例（43.97%），老年患者511例（56.03%）；MMI组159例（17.43%），非MMI组753例（82.57%）。多变量logistic回归分析显示，高血压[优势比（odds ratio, OR）6.962，95%可信区间（confidence interval, CI）1.349～35.934；P＝0.021]和美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分（OR 1.551，95% CI 1.384～1.737；P〈0.001）是MMI的独立危险因素。亚组分析显示，中青年患者中NIHSS评分（OR 1.402，95% CI 1.239～1.588；P〈0.001）是MMI的独立危险因素；老年患者中高血压（OR 10.752，95% CI 1.213～95.295；P＝0.033）、舒张压（OR 1.080，95% CI 1.002～1.164；P＝0.044）和NIHSS评分（OR 1.504，95% CI 1.281～1.765；P〈0.001）是MMI的独立危险因素，而收缩压（OR 0.938，95% CI 0.893～0.986；P＝0.011）是MMI的独立保护因素。 结论基线NIHSS评分是所有年龄段患者MMI的独立危险因素。在老年患者中，高血压和舒张压是MMI的独立危险因素，而收缩压则是独立保护因素。因此，及时进行NIHSS评估并适当调控高血压对MMI的防治具有重要意义。

ObjectiveTo investigate the risk factors for malignant middle cerebral artery infarction （MMI） in different age groups. MethodsPatients with middle cerebral artery infarction were analyzed retrospectively. They were divided into a young and middle-aged group （〈60 years） and an elderly group （≥60 years）. The demography and vascular risk factors, stroke etiologies, baseline blood pressure, drug use before onset and common blood test results in patients with MMI and non-MMI were compared in general cases and each age group. Multivariate logistic regression analysis was used to determine the independent risk factors for MMI. ResultsA total of 912 patients with middle cerebral artery infarction were enrolled, including 299 females （32.79%） and 613 males （67.21%）; 401 young and middle-aged patients （43.97%） and 511 elderly patients （56.03%）; 159 patients in the MMI group （17.43%）, and 753 （82.57%） in the non-MMI group. Multivariable logistic regression analysis showed that hypertension （odds ratio [OR]6.962, 95% confidence interval [CI]1.349-35.934; P=0.021） and NIHSS score （OR 1.551, 95% CI 1.384-1.737; P〈0.001） were the independent risk factors for MMI. Subgroup analysis showed that NIHSS score （OR 1.402, 95% CI 1.239-1.588; P〈0.001） was an independent risk factor for MMI in young and middle-aged patients; hypertension （OR 10.752, 95% CI 1.213-95.295; P=0.033）, diastolic blood pressure （OR 1.080, 95% CI 1.002-1.164; P=0.044）, and NIHSS score （OR 1.504, 95% CI 1.281-1.765; P〈0.001） were the independent risk factor for MMI in the elderly patients, while systolic blood pressure （OR 0.938, 95% CI 0.893-0.986; P=0.011） was an independent protective factor. ConclusionsThe baseline NIHSS score was an independent risk factor for MMI in each age group. Hypertension and diastolic blood pressure were the independent risk factors for MMI in the elderly patients, while systolic pressure was an independent protective factor. Therefore, timely NIHSS assessment and appropriate hypertension management had important significance for the prevention and treatment of MMI.