溶栓时间窗外急性大脑中动脉闭塞患者进展性运动功能缺损的危险因素分析

Risk factors of progressive motor deficit in patients with acute middle cerebral artery occlusion beyond thrombolysis time

目的探讨溶栓时间窗外急性大脑中动脉闭塞（MCAO）患者发生进展性运动功能缺损（PMD）的相关危险因素。方法回顾性分析中南大学湘雅医学院附属海口医院神经内科自2015年3月至2017年3月收治的123例溶栓时间窗外急性MCAO患者的临床资料．并根据患者入院5d内是否出现美国国立卫生研究院卒中量表（NIHSS）运动项目评分增加〉2分且持续〉24h将患者分为PMD组和非PMD组，采用单因素分析及多因素Logistic回归分析模型从所有可能影响患者发生PMD的临床指标中筛选出PMD的危险因素。结果123例患者中出现PMD者51例（41．5％），未出现PMD者72例（58．5％）。单因素分析显示，PMD组和非PMD组在入院时随机血糖水平、PH2型出血转化比例、内分水岭梗死模式、放射冠区梗死部位及侧支循环通路开放不良方面差异均有统计学意义（P〈0．05）。多因素Logistic回归分析显示，PH2型出血转化、放射冠区梗死部位、内分水岭梗死模式及侧支循环通路开放不良是PMD的危险因素（OR=2．857，95％CI：1．037～7．869，P=0．042；OR=2．585，95％CI：1．219-5．481，P=0．013；OR=2．876，95％CI：1．327-6．232，P=0．007；OR=2．332，95％CI：1．120-4．867，P=0．024）。结论PH2型蹦血转化、放射冠区梗死部位、内分水岭梗死模式、侧支循环通路开放不良对溶栓时间窗外急性MCAO患者发生PMD有显著影响。

Objective To investigate the risk factors of progressive motor deficit （PMD） in patients with acute middle cerebral artery occlusion （MCAO） beyond thrombolysis time. Methods The clinical data of 123 patients with acute MCAO beyond thrombolysis time, admitted to our hospital from March 2015 to March 2017, were analyzed retrospectively. According to whether patients having National Institute of Health Stroke Scale （NIHSS） scores increased〉2 within 5 d of admission and continued for 24 h, these patients were divided into two groups： PMD group and non-PMD group. Single factor analysis was performed on all clinical parameters that might influence PMD; in addition, the influencing factors of PMD were analyzed by multiple factor Logistic regression analysis. Results Fifty-one patients （41.5%） had PMD and 72 patients （58.5%） did not have PMD. Single factor analysis showed that the differences of randomized blood glucose level, ratio of patients with PH2 type hemorrhagic transformation, intracurricular infarct pattern, radiation crown infarct and collateral circulation pathway between the PMD group and the non-PMD group were statistically significant （P〈 0.05）. Multiple factor Logistic regression analysis showed that ratio of patients with PH2 type hemorrhagic transformation, radiation infarct site, internal watershed infarct model and collateral circulation pathway were significantly correlated to PMD （OR=2.857, 95%CI： 1.037-7.869,P=0.042;OR=2.585, 95%CI： 1.219-5.481, P=0.013; OR=2.876, 95%CI： 1.327-6.232, P=0.007; OR=2.332, 95%CI： 1.120-4.867, P=-0.024）. Conclusion PH2 type hemorrhagic transformation, corona radiate infarct, internal watershed infarct model and insufficient collateral circulation pathway are the important risk factors of PMD in patients with acute MCAO beyond thrombolysis time.