老年轻型缺血性脑卒中早期进展的临床研究

Early progression of mild ischemic stroke in the elderly

目的探讨老年轻型缺血性脑卒中早期神经功能缺损加重的相关因素。方法选择2013年6月~2017年7月在北京市中关村医院神经内科住院的轻型缺血性脑卒中患者200例,美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分≤3分,根据病情是否进展分为进展组52例,非进展组148例。对比分析2组患者既往病史、临床症状、体征及实验室检查结果、影像资料。结果进展组糖尿病、脑卒中、血压节律异常、NIHSS评分、高敏C反应蛋白、血管狭窄闭塞、多发病灶、分水岭区脑梗死比例明显高于非进展组,差异有统计学意义(P<0.05,P<0.01)。多元logistic回归分析显示,高敏C反应蛋白(OR=3.113,95%CI:1.483~6.532,P=0.003)、血压节律异常(OR=2.724,95%CI:1.291~5.749,P=0.009)、血管狭窄闭塞(OR=3.499,95%CI:1.557~7.860,P=0.002)、多发病灶(OR=2.794,95%CI:1.359~5.744,P=0.005)及分水岭区脑梗死(OR=3.843,95%CI:1.752~8.426,P=0.001)为老年轻型脑卒中早期进展的独立预测因素。结论高敏C反应蛋白、血压节律异常、血管狭窄闭塞、多发病灶及分水岭区脑梗死可能为老年轻型缺血性脑卒中早期进展的预测因素。

Objective To study the risk factors for early neurological deterioration（END）in elderly mild ischemic stroke（MIS）patients.Methods Two hundred MIS patients with their national institute of health stroke scale（NIHSS）score≤3 admitted to the Beijing Zhongguancun Hospital from June 2013 to July 2017 were divided into progressive ischemic stroke group（n=52）and nonprogressive ischemic stroke group（n=148）.Their past medical history,clinical symptoms,laboratory testing parameters,and imaging data were compared and analyzed.Results The incidence of diabetes mellitus and ischemic stroke,abnormal circadian rhythm of blood pressure,NIHSS score,serum hs-CRP level,incidence of blood vessel stenosis or occlusion,multiple lesions and watershed cerebral infarction were significantly higher in progressive ischemic stroke group than in non-progressive ischemic stroke group（P〈0.05,P〈0.01）.Multivariate logistic regression analysis showed that hs-CRP,abnormal circadian rhythm of blood pressure,blood vessel stenosis or occlusion,multiple lesions,and watershed cerebral infarction were the independent risk factors for END in elderly MIS patients（OR=3.113,95%CI：1.483-6.532,P=0.003;OR=2.724,95%CI：1.291-5.749,P=0.009;OR=3.499,95%CI：1.557-7.860,P=0.002;OR=2.794,95%CI：1.359-5.744,P=0.005;OR=3.843,95%CI：1.752-8.426,P=0.001）.Conclusion hs-CRP,abnormal circadian rhythm of blood pressure,blood vessel stenosis or occlusion,multiple lesions and watershed cerebral infarction are the independent risk factors for END in elderly MIS patients.