进展性大动脉粥样硬化型脑梗死的危险因素分析

Risk factors of progressive ischemic stroke due to large-artery atherosclerosis

目的探讨中国缺血性脑卒中亚型(CISS)分型中大动脉粥样硬化型(LAA)脑梗死病情进展的危险因素。方法前瞻性收集急性LAA脑梗死患者,根据美国国立卫生研究院卒中量表(NIHSS评分)评估患者病情是否进展,对可能影响患者病情进展的因素进行统计分析。结果共纳入351例患者,其中进展组112例(31.91%),非进展组239例(68.09%)。单因素分析2组患者高血压病史、饮酒史、空腹血糖、白细胞总数、纤维蛋白原水平、入院时收缩压及舒张压、入院时NIHSS评分、颅内外血管重度狭窄/闭塞、肺部感染、泌尿系感染、电解质紊乱有明显差异(P<0.1),多因素Logistic逐步回归分析显示入院时收缩压、白细胞总数、颅内外血管重度狭窄/闭塞、纤维蛋白原水平、肺部感染、相较于轻度神经功能缺损的中度及重度神经功能缺损是进展性LAA脑梗死的独立危险因素。结论入院收缩压增高、白细胞总数增高、颅内外血管重度狭窄/闭塞、纤维蛋白原水平增高、肺部感染、中度及重度神经功能缺损是进展性LAA脑梗死的独立危险因素。

Objective To investigate the risk factors of progressive ischemic stroke due to large-artery atherosclerosis(LAA)in Chinese Ischemic Stroke Subclassification(CISS)classification.Methods The patients with acute LAA cerebral infarction were prospectively collected,according to the National Institutes of Health Stroke Scale(NIHSS)score to assess whether the patient's condition progressed,and the factors which might affect the patient's disease progression were statistical analyzed.Results A total of 351 patients were included, including 112(31.91%)in the progressive group and 239(68.09%)in the non-progressive group. There were statistical differences in hypertension history,drinking history,fasting blood glucose,total white blood cell count,fibrinogen,admission systolic and diastolic blood pressure,admission NIHSS score,severe stenosis/occlusion of intracranial and extracranial vessels,pulmonary infection,urinary tract infection,and electrolyte imbalance between two groups(P<0.1),multivariate logistic stepwise regression analysis showed that systolic blood pressure at admission,total white blood cell count,severe stenosis/occlusion of intracranial and extracranial vessels,fibrinogen,pulmonary infection,and moderate and severe neurological deficits relative to mild neurological deficits were independent risk factors of progressive ischemic stroke due to LAA. Conclusion Increased systolic blood pressure,increased white blood cell count,severe stenosis/occlusion of intracranial and extracranial vessels,increased fibrinogen,pulmonary infection,moderate and severe neurological deficits were independent risk factors of progressive ischemic stroke due to LAA.