进展性脑梗死预后不良的危险因素分析

Analysis of the risk factors for poor prognosis of progressive cerebral infarction

目的 分析影响进展性脑梗死不良预后的危险因素.方法 回顾性分析2013年1月至2017年3月枣庄市皮肤病性病防治院收治的脑梗死患者326例的临床资料,根据住院期间病情进展情况分为预后不良组(n=148)和良好组(n=178),采用单因素分析和多因素logistic回归分析探讨影响预后的危险因素.结果 两组患者性别构成、年龄、舒张压、低密度脂蛋白(LDL)、大脑前动脉狭窄、大脑后动脉狭窄、椎基底动脉狭窄等因素差异均无统计学意义(均P>0.05);不良组患者高血压史(60.81%比48.88%,χ^2=1.683,P=0.031)、糖尿病史(41.89%比30.90%,χ^2=4.244,P=0.039)、高脂血症史(62.84%比49.44%,χ^2=5.875,P=0.015)的发生率均高于良好组;不良组患者收缩压低于良好组[(144±17) mmHg比(150±22) mmHg,t=2.928,P=0.004)];不良组体温[(38.10±0.22)℃比(38.03±0.34)℃,t=2.240,P=0.026]、空腹血糖[(7.85±1.95) mmol/L比(6.91±1.77) mmol/L,t=4.558,P=0.000]、总胆固醇[(5.21±1.66) mmol/L比(4.84±1.55)mmol/L,t=2.708,P=0.039]、甘油三酯[(2.49±0.79 mmol/L比(2.30±0.54) mmol/L,t=2.483,P=0.014]、高密度脂蛋白[(1.30 ±0.51)mmol/L比(1.17±0.44) mmol/L,t=2.470,P=0.014]和纤维蛋白原[(4.37±1.67)g/L比(3.79±1.42)g/L,t=3.339,P=0.001]、颈内动脉处狭窄(31.08%比20.79%,χ^2=4.636,P=0.031)、大脑中动脉处狭窄(39.86%比29.21%,χ^2=4.083,P=0.043)、颈内动脉斑块(48.65%比36.52%,χ^2=4.882,P=0.027)等指标均高于良好组;多因素回归分析发现,高血压史、糖尿病史、高脂血症史、发热、血压下降、总胆固醇、甘油三酯、高密度脂蛋白、纤维蛋白原等是影响进展性脑梗死预后的因素.结论 影响进展性脑梗死不良预后的危险因素较多,生理病理机制复杂,临床治疗中,应重视患者既往所患疾病情况,并针对不同的机制进行预防和治疗.

Objective To analyze the risk factors affecting the poor prognosis of progressive cerebral infarction.Methods The clinical data of 326 patients with cerebral infarction admitted to Dermatology and Venereal Disease Prevention and Cure Hospital of Zaozhuang from January 2013 to March 2017 were retrospectively analyzed.The patients were divided into poor prognosis group(n =148) and good prognosis group(n =178) according to their prognosis during hospitalization.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors affecting prognosis.Results Statistical analysis showed that there were no statistically significant differences in sex composition,average age,diastolic blood pressure,LDL,anterior cerebral artery stenosis,posterior cerebral artery stenosis and vertebral basilar artery stenosis between the two groups (all P > 0.05).The incidence rates of hypertension history (60.81% vs.48.88%,χ^2 =1.683,P =0.031),diabetes history (41.89% vs.30.90%,χ^2 =4.244,P =0.039),hyperlipidemia history (62.84% vs.49.44%,χ^2 =5.875,P =0.015) in the poor prognosis group were higher than those in the good prognosis group.The systolic blood pressure in poor prognosis group was lower than that in the good prognosis group [(144 ± 17) mmHg vs.(150 ± 22) mmHg,t =2.928,P =0.004].The body temperature [(38.10 ± 0.22) ℃ vs.(38.03 ± 0.34) ℃,t =2.240,P =0.026],FPG [(7.85 ± 1.95) mmol/L vs.(6.91 ± 1.77) mmol/L,t =4.558,P =0.000],TC [(5.21 ± 1.66) mmol/L vs.(4.84 ± 1.55) mmol/L,t =2.708,P =0.039],TG [(2.49 ± 0.79 mmol/L vs.(2.30 ± 0.54) mmol/L,t =2.483,P =0.014],HDL [(1.30 ± 0.51) mmol/L vs.(1.17 ±0.44)mmol/L,t=2.470,P=0.014] and FIB[(4.37± 1.67)g/L vs.(3.79 ± 1.42)g/L,t =3.339,P=0.001],stenosis of internal carotid artery (31.08% vs.20.79%,χ^2 =4.636,P =0.031),stenosis of middle cerebral artery (39.86% vs.29.21%,χ^2 =4.083,P =0.043),and plaque of internal carotid artery (48.65% vs.36.52%,χ^2 =4.882,P =0.027) in the poor prognosis group were higher than those in the good prognosis group.Multivariate regression analysis showed that history of hypertension,diabetes,hyperlipidemia,fever,decreased blood pressure,elevated TC,elevated TG,elevated HDL and elevated FIB were the risk factors for the prognosis of progressive cerebral infarction.Conclusion There are many risk factors affecting the poor prognosis of progressive cerebral infarction,and the physiological mechanism is complex.In clinical treatment,attention should be paid to patients'past diseases,prevention and treatment should be carried out according to different mechanisms.