急性缺血性脑卒中动脉通畅性恶化的相关因素及预后

Related factors and prognosis of arterial patency deterioration in patients with acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)动脉通畅性恶化(APD)的相关因素及预后。方法收集778例AIS患者的临床资料。根据是否发生APD将患者分为APD组及非APD组。于入院时和入院24 h对患者进行头颅MRI检查。采用NIHSS评分评价入院24 h神经功能,记录入院48 h的早期缺血性卒中复发率;于3个月和12个月采用mRS评分评估预后;记录第7 d、3个月、12个月的死亡率。结果与非APD组比较,APD组年龄、3个月mRS评分及高血压病史、入院前使用降压药、入院前使用降脂药、脑白质疏松的比率显著降低,入院及24 h NIHSS评分、12个月mRS评分及意识水平下降、颅内动脉狭窄、颅外动脉狭窄和侧支循环状态良好的比率显著升高(均P<0.05)。两组间TOAST分型的其他明确病因型卒中(SOE)及不明病因型卒中(SUE)差异有统计学意义(P=0.000,P=0.028)。Logistic回归分析显示,高血压病史(OR=0.46,95%CI:0.30-0.85,P=0.002)、入院NIHSS评分(OR=1.06,95%CI:1.03-1.11,P<0.001)、颅内动脉狭窄(OR=4.87,95%CI:3.02-15.21,P<0.001)、颅外动脉狭窄(OR=3.61,95%CI:1.59-6.37,P=0.011)和侧支循环状态良好(OR=3.17,95%CI:1.45-9.85,P=0.002)是APD的独立相关因素。与非APD组比较,APD组早期神经功能恶化、早期卒中复发比率显著升高(均P<0.001),第7 d、3个月、12个月的死亡率及3个月、12个月的预后不良率显著升高(均P<0.05)。结论入院NIHSS评分、颅内和颅外动脉狭窄及侧支循环状态良好与入院24 h APD独立相关,高血压病史具有保护作用。APD早期及长期预后均不佳。

Objective To investigate the related factors and prognosis of arterial patency deterioration(APD) in patients with acute ischemic stroke(AIS).Methods Clinical data of 778 AIS patients were collected. According to APD, patients were divided into the APD group and the non-APD group. Brain MRI was checked at admission and 24 h after admission. Nerve function at 24 h after admission was evaluated by NIHSS, and the recurrence rate of ischemic stroke at early stage was recorded at 48 h after admission. Prognosis was evaluated by mRS at 3 rd month and 12 th month, and the mortality rate was recorded at 7 th d, 3 rd month and 12 th month.Results Compared with those in non-APD group, age, mRS score at 3 rd month and the rates of hypertension history, took hypotensive drugs at admission, took lipid-lowering medicine at admission, leukoaraiosis in APD group were significantly decreased, NIHSS score at admission and 24 h after admission, mRS score at 12 th month and the rates of consciousness level decreased, intracranial artery stenosis, extracranial artery stenosis, good collateral circulation were significantly increased(all P<0.05). The rate of stroke of other demonstrated etiology and stroke of undemonstrated etiology of TOAST between two groups had statistical significance(P=0.000, P=0.028). Logistic regression analysis showed hypertension history(OR=0.40, 95%CI: 0.17-0.92, P=0.032), NIHSS score at admission(OR=1.16, 95%CI: 1.09-1.24, P<0.001), intracranial stenosis(OR=5.00, 95%CI: 1.63-15.31, P=0.005), extracranial stenosis(OR=3.30, 95%CI: 1.25-8.77, P=0.016), and good collateral circulation(OR=4.00, 95%CI: 1.47-10.92, P=0.007) were independent predictors of APD. Compared with those in non-APD group, neurological worsening and recurrence rate of ischemic stroke at early stage were significantly increased(all P<0.001), and the rates of poor prognosis at 7 th d, 3 rd month and 12 th month were significantly increased(all P<0.05).Conclusions NIHSS score at admission, intracranial stenosis, extracranial stenosis, and good collateral circulation are independent predictors of APD,and hypertension history has a protective effect. The early and longterm prognosis of patients experiencing APD are poor.