脑梗死急性期病情恶化与侧支循环的相关性

The correlation between early neurological deterioration and collateral circulation in patients with acute cerebral infarction

目的探讨脑梗死急性期病情恶化(END)与侧支循环的相关性。方法收集2016年1月-2018年12月江门市人民医院神经内科住院的72 h内完成DSA检查的脑梗死急性期患者237例,根据住院期间是否出现END分为nEND组(182例)与END组(55例),多变量logistic分析确定脑梗死急性期病情恶化的独立危险因素。结果侧支循环良好158例,其中23例(14.6%)发生END;侧支循环不良79例,32例(40.5%)发生END,侧支循环不良患者END发病率显著增加(P<0.05)。单因素分析显示,END组与nEND组患者糖尿病病史(P=0.016)、收缩压(P=0.026)、低密度脂蛋白(P=0.019)、空腹血糖(P=0.023)、超敏C反应蛋白(P=0.029)、基线NIHSS评分(P=0.000)、大动脉狭窄或闭塞(P=0.008)及侧支循环(P=0.000)有明显差异,其余变量无明显差异(P>0.05)。多变量logistic分析显示,END的独立危险因素为NIHSS评分(OR=0.777,95%CI=0.654~0.924,P=0.004)、大动脉狭窄或闭塞(OR=2.298,95%CI=1.019~5.180,P=0.045)和侧支循环不良(OR=6.289,95%CI=3.007~13.156,P=0.000)。结论脑梗死END发生与侧支循环不良有明显关系。

Objective To investigate the correlation between early neurological deterioration(END) and collateral circulation in patients with acute cerebral infarction. Methods Patients with acute cerebral infarction who completed DSA examination within 72 hours from January 2016 to December 2018 in the Department of Neurology, Jiangmen people’s hospital were collected and divided into END group and nEND group. Multivariate logistic analysis was used to determine the independent risk factors of END of acute cerebral infarction. Results END were observed in 23 of 158 patients with good collateral circulation(14.6%) and in 32 of 79 patients with poor collateral circulation(40.5%)(P<0.05). The single factor analysis showed that the history of diabetes mellitus(P=0.016), systolic blood pressure(P=0.026),fasting blood glucose(P=0.023), low-density lipoprotein(P=0.019), high sensitive C-reactive protein(P=0.029), baseline NIHSS score(P=0.000), aortic stenosis or occlusion(P=0.008) and collateral circulation(P=0.000) were statistically different between END and nEND groups, other variables were no statistical difference(P>0.05). Multivariate logistic analysis showed that the END were independently associated with NIHSS score(OR=0.777, 95%CI=0.654~0.924, P=0.004), large artery stenosis or occlusion(OR=2.298,95%CI=1.019~5.180,P=0.045) and poor collateral circulation(OR=6.289, 95% CI=3.007~13.156, P=0.000). Conclusion The occurrence of END in cerebral infarction was significantly correlated with poor collateral circulation.