缺血性卒中溶栓后早期神经功能恶化的危险因素及预后相关性研究

Study on the Relationship Between Risk Factors and Prognosis of Early Neurological Deterioration After Thrombolysis in Patients with Ischemic Stroke

目的 探讨急性缺血性卒中患者溶栓后24 h早期神经功能恶化(END)的发生率、预测相关因素以及与预后的相关性.方法 前瞻性纳入2017年9月—2018年12月行rt-PA静脉溶栓的急性缺血性卒中患者,根据有无END的发生分为END组(研究组)和非END组(对照组).收集患者临床资料,分析急性缺血性卒中患者END的危险因素和预后.结果 共纳入急性脑梗死并接受溶栓治疗患者464例,排除桥接血管内治疗20例、资料不全2例和失访3例,最终439例纳入分析,其中研究组35例,对照组404例,END发生率为7.97%,两组患者的一般特征比较其中既往高血压病史(P=0.017),既往糖尿病病史(P=0.000),既往卒中病史(P=0.042),基线血糖(P=0.003)、基线收缩压(P=0.020)、基线NISHH评分(P=0.018)、空腹血糖水平(P=0.018)的差异有统计学意义.进一步Logistic多因素回归分析,入院时收缩压高、既往糖尿病病史、既往高血压病史与END的发生独立相关(P<0.05);研究组预后不良的比例为60.00%,对照组预后不良的比例为26.98%,研究组较对照组更容易出现预后不良(OR=3.687,95%CI:1.748~7.776).结论 既往高血压病史、既往糖尿病病史和入院时较高的收缩压是急性缺血性卒中静脉溶栓治疗后发生END的独立危险因素;溶栓后END的发生与3个月不良预后密切相关.

Objective To investigate the incidence,predictive factors and prognosis of early neurological deterioration(END)in patients with acute ischemic stroke 24 hours after thrombolysis.Methods Patients with acute ischemic stroke who underwent recombinant tissue plasminogen activator intravenous thrombolysis in Fushun Central Hospital from September 2017 to December 2018 were selected.According to the occurrence of END,the patients were divided into END group(study group)and non-END group(control group).The clinical data of the patients and the score of the National Institutes of Health Stroke scale(NIHSS)were collected to analyze the risk factors and prognosis of END in patients with acute ischemic stroke.Results A total of 464 patients with acute cerebral infarction and thrombolytic therapy were included,including 20 cases of subsequent bridging endovascular therapy,2 cases of incomplete data and 3 cases of missing follow-up.439 cases were included in the analysis,including 35 cases in the study group and 404 cases in the control group.The incidence of END was 7.97%.The general characteristics of the two groups were compared with the previous history of hypertension(P=0.017),the previous history of diabetes(P=0.000),previous stroke history(P=0.042),baseline blood glucose(P=0.003),and baseline systolic blood pressure(P=0.020).There were significant differences in baseline NISHH score(P=0.018)and fasting blood glucose level(P=0.018).Further Logistic multivariate regression analysis showed that high systolic blood pressure at admission,past history of diabetes and past history of hypertension were independently correlated with the occurrence of END(P<0.05).The ratio of bad prognosis was 60.00%in the study group and 26.98%in the control group.There was a significant difference in prognosis between the two groups(OR=3.687,95%CI:1.748-7.776).Conclusion The previous history of hypertension,previous history of diabetes and high systolic blood pressure at admission are independent risk factors for END after intravenous thrombolytic therapy in patients with acute ischemic stroke,and the occurrence of END after thrombolysis is closely related to the adverse prognosis of 3 months.