西安地区急性脑梗死患者1年预后不良的相关危险因素分析

Risk factors for poor outcome in patients one year after acute cerebral infarction in Xi'an district

目的探讨西安地区急性脑梗死患者1年预后不良的相关危险因素。方法通过西安脑卒中数据库平台,收集2015年1月1日~12月31日4所三级甲等医院连续入院的急性脑梗死患者2016例,并分别在患者发病1、3、6个月以及1年时进行随访,以1年随访时改良Rankin评分(mRS评分)分为预后良好组(mRS评分≤2分)1660例,预后不良组(mRS评分≥3分)356例。通过单因素和多因素logistic回归分析急性脑梗死患者1年预后不良的危险因素。结果 2组年龄、入院48h不能行走、入院美国国立卫生研究院卒中量表(NIHSS)评分和白细胞计数比较,差异有统计学意义(P<0.01)。多因素logistic回归分析显示:年龄>60岁(OR=2.37,95%CI:1.49~3.77,P=0.001)、心房颤动(OR=2.61,95%CI:1.42~4.80,P=0.002)、入院NIHSS评分(OR=1.15,95%CI:1.10~1.21,P=0.001)、入院48h不能行走(OR=2.37,95%CI:1.54~3.65,P=0.001)、白细胞计数>10×109/L(OR=1.49,95%CI:1.09~2.72,P=0.010)是急性脑梗死患者1年预后不良的独立危险因素。结论早期识别预后不良危险因素,关注高危人群、进行有针对性的预防,有助于降低急性脑梗死患者1年不良预后的风险。

Objective To study the risk factors for poor outcome in patients one year after acute cerebral infarction(ACI)in Xi’an district.Methods A total of 2016 ACI patients admitted to 4 tertiary class A hospitals were followed up at months 1,3,6 and 12 after onset of stroke.The patients were divided into good outcome group(mRS≤2,n=1660)and poor outcome group(mRS≥3,n=356)according to their mRS score at month 12 after onset of stroke.The risk factors for poor outcome at month 12 after onset of stroke were analyzed by univariate and multivariate logistic regression analysis.Results A significant difference was found in age,inability to walk within48 hafter admission,NIHSS score on admission and leukocytes between the two groups(P<0.01).Multivariate logistic regression analysis showed that age>60 years,AF,NIHSS score on admission,inability to walk within 48 hafter admission,and leukocytes>10×109/L were the independent risk factors for poor coutcome in patients one year after onset of stroke in Xi’an district(OR=2.37,95%CI:1.49-3.77,P=0.001;OR=2.61,95%CI:1.42-4.80,P=0.002;OR=1.15,95%CI:1.10-1.21,P=0.001;OR=2.37,95%CI:1.54-3.65,P=0.001;OR=1.49,95%CI:1.09-2.72,P=0.010).Conclusion Early identification of risk factors for poor outcome,attention paid to high-risk populations,and targeted intervention contribute to reducing the risk factors for poor outcome in patients 1 year after onset of stroke.