高龄老年轻型缺血性卒中患者临床特点和中期预后分析

Analysis of clinical characteristics and medium-term prognosis of advanced elderly patients with mild ischemic stroke

目的评估高龄老年轻型缺血性卒中患者的临床特点及中期预后情况,分析临床转归差的危险因素。方法回顾性研究,入选2016年1月至2017年12月入住聊城第二人民医院神经内科的老年轻型急性缺血性脑卒中患者574例,根据年龄分为80~88岁组276例,60~79岁组298例。分析两组的临床特点,并随访12个月,评估两组中期预后情况,分析影响临床转归差[改良Rankin量表(mRS)评分≥3分]的危险因素。结果与60~79岁组患者比较,80~88岁组患者多合并心房颤动、糖尿病和卒中病史(均P<0.05)。80~88岁组与60~79岁组患者比较,美国国立卫生研究院卒中量表(NIHSS)评分(1.37±1.03)分比(0.94±0.43)分,mRS评分(2.79±1.27)分比(1.92±0.66)分(均P<0.05),80~88岁组患者抗凝治疗比例较低,但两组差异无统计学意义。平均随访(11.3±1.5)个月,80~88岁组与60~79岁组患者比较,临床转归差[63.4%(175例)比48.0%(143例)],病死率[25.7%(71例)比16.1%(48例)]高(均P<0.05)。Cox风险比例回归分析模型显示,年龄、基线NIHSS评分、基线mRS评分、糖尿病和卒中病史是老年轻型卒中患者临床转归差的危险因素(均P<0.05)。结论高龄老年轻型卒中患者多合并心房颤动、糖尿病和卒中病史,中期预后差。年龄、基线NIHSS评分、基线mRS评分、糖尿病和卒中病史是老年轻型卒中患者临床转归差的危险因素。

Objective To investigate clinical characteristics and medium-term prognosis of the advanced elderly patients with mild ischemic stroke, and to evaluate the risk factors for poor clinical outcome. Methods The 574 elderly patients with mild acute ischemic stroke admitted in neurology department of our hospital were retrospectively studied from January 2016 to December 2017.All cases were divided into the advanced elderly group(n=276,≥80 years old)and elderly patient group(n=298, 60-79 years old). Clinical characteristics were analyzed.After 12-month follow-up, the mid-term prognosis and risk factors for poor clinical outcome(mRS≥3)were analyzed in the two groups. Results Compared with the elderly patients, the advanced elderly patients were more often complicated with history of atrial fibrillation, diabetes and stroke(P<0.05). The scores of National Institute of Health stroke scale(NIHSS)and Modified Rankin Scale(mRS)were higher in the advanced elderly patients than in the elderly patients(1.37±1.03 vs.0.94±0.43, 2.79±1.27 vs.1.92±0.66, P<0.001). The proportion of patients receiving anticoagulation treatment were lower in the advanced elderly patients than in the elderly patients, with no significant difference(P>0.05). After an average follow-up of(11.3±1.5)months, the proportions of poor clinical outcome and mortality were higher in the advanced elderly patients than in the elderly patients(63.4% or 175/276 vs.48.0% or 143/298, 25.7% or 71/276 vs.16.1% or 48/298, P<0.05). Cox proportional hazard model analysis showed that age, baseline NIHSS score and mRS score, diabetes and stroke history were the risk factors for poor clinical outcome in elderly patients with mild ischemic stroke(all P<0.05). Conclusions The advanced elderly patients with mild ischemic stroke have a severe clinical condition, higher rates of atrial fibrillation, diabetes and stroke history, and poor mid-term prognosis.Age, baseline scores of NIHSS and mRS, diabetes and stroke history are the risk factors for poor clinical outcome in elderly patients with mild ischemic stroke.