急性豆纹动脉梗死患者短期预后的影响因素分析

Analysis of Factors Influencing Short-term Prognosis in Patients with Acute Lenticulostriate Arteries Infarction

目的分析急性豆纹动脉(lenticulostriate arteries,LSA)梗死患者短期预后的影响因素。方法纳入研究2017年1月至2018年12月锦州医科大学附属第一医院神经内科住院治疗的112例(45~80岁)诊断为急性LSA梗死的患者,按发病后第14天改良的Rankin评分(modified rankin scale,MRS)分为两组:预后良好组(MRS≤2,n=78)、预后不良组(MRS>2,n=34)。采用单因素分析评估可能影响预后的因素,将有统计学意义的指标纳入二元Logistic分析,分析独立的影响因素。进一步应用两独立样本t检验在预后良好组进行亚组分析。结果急性LSA梗死患者预后良好组与预后不良组比较,患者吸烟史、基线NIHSS评分、入院后第14天MCA-PI水平、抗血小板、抗凝治疗、他汀治疗、马来酸桂哌齐特治疗在两组间的差异具有显著性(P<0.05);Logistic回归分析显示,基线NIHSS水平、入院后第14天MCA-PI水平、马来酸桂哌齐特治疗是影响急性豆纹动脉梗死预后的独立因素;马来酸桂哌齐特组入院后第14天MCA-PI水平低于非马来酸桂哌齐特组,差异有统计学意义(P<0.05)。结论基线的低NIHSS评分、入院后第14天的低PI值以及应用马来酸桂哌齐特治疗是急性LSA梗死患者短期预后良好的影响因素,马来酸桂哌齐特可能通过降低远端脑小血管的阻力来改善急性LSA梗死患者的预后。

Objective To analyze the influencing factors of short-term prognosis in patients with acute lenticulostriate arteries(LSA)infarction.Methods 112 patients(45-80 years old)diagnosed with acute LSA infarction and hospitalized in the Department of Neurology,the First Affiliated Hospital of Jinzhou Medical University from January 2017 to December 2018 were divided into two groups,the good prognosis group(MRS≤2,n=78)and the poor prognosis group(MRS>2,n=34)according to the modified Rankin Scale(MRS)on the 14th day after onset.A single factor analysis was used to evaluate the factors that may affect the prognosis,and statistically significant indicators were included in the binary Logistic analysis to analyze independent influencing factors.Further,two independent sample t-tests were used to perform subgroup analysis in the prognosis group.Results There were significant differences between patients with acute LSA infarction in good prognosis group and those in poor prognosis group in terms of smoking history,baseline NIHSS score,MCA-PI level 14 days after admission,antiplatelet,anticoagulant therapy,statin therapy and noripazide maleate treatment(P<0.05).Logistic regression analysis showed baseline NIHSS level,MCA-PI level on the 14th day after admission and cinnamon maleate treatment were independent factors affecting the prognosis of lenticulostriate arteries infarction;On the 14th day after admission,the level of MCA-PI in the guipiazide maleate group was lower than that in the non-guipiazide group,and the difference was statistically significant(P<0.05).Conclusion Low NIHSS score at baseline and low PI values on the 14th day after onset,and application of cinepazide maleate are good predictors of short-term prognosis in patients with acute LSA.Cinepazide maleate may improve prognosis in patients with acute LSA infarction by reducing resistance to distal small cerebral vessels.