急性脑梗死患者发生早期神经功能恶化的危险因素研究

Risk Factors of Early Neurological Deterioration in Patients with Acute Cerebral Infarction

背景急性脑梗死的早期神经功能恶化(END)是临床常见的一种脑血管病,是影响患者预后的重要因素。急性脑梗死患者发生END的病因及机制目前尚不完全明确,且无统一的诊断标准,缺乏可靠的预测、评估指标及预防措施。目的探讨急性脑梗死患者发生END的危险因素。方法选取任丘康济新图医院神经内科2014年1月—2018年11月收治的急性脑梗死住院患者3997例为研究对象,其中发生END 136例(END组),未发生END 3861例(非END组)。收集患者一般资料〔包括性别、年龄、体质指数(BMI)、病史(高血压病史、糖尿病病史、高脂血症病史、脑血管病病史、心房颤动病史、冠心病病史)、吸烟情况、过量饮酒情况、抗血小板药物使用情况、脑梗死分型(TOAST分型)、入院收缩压、入院舒张压、入院美国国立卫生研究院卒中量表(NIHSS)评分〕、实验室指标〔白细胞计数(WBC)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)、纤维蛋白原(FIB)〕、彩色多普勒超声检查结果〔颈动脉斑块形成、颈动脉狭窄发生情况〕。急性脑梗死患者发生END的影响因素分析采用单因素、多因素Logistic回归分析。结果END组年龄大于非END组,入院收缩压、入院NIHSS评分、FPG、TC及颈动脉斑块形成、颈动脉狭窄发生率高于非END组(P<0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.025,95%CI(1.008,1.043)〕、入院收缩压〔OR=1.010,95%CI(1.004,1.017)〕、入院NIHSS评分〔OR=1.048,95%CI(1.010,1.088)〕、TC〔OR=1.165,95%CI(1.010,1.344)〕、颈动脉狭窄〔OR=1.669,95%CI(1.154,2.414)〕是急性脑梗死患者发生END的独立影响因素(P<0.05)。结论高龄和收缩压、NIHSS评分、TC升高及颈动脉狭窄是急性脑梗死患者发生END的独立危险因素,应早期积极干预相关危险因素,以降低患者致残率,提高其生活质量。

Background Early neurologic deterioration(END)of acute cerebral infarction is a common cerebrovascular disease in clinics,which is an important factor affecting the prognosis of patients.The etiology and mechanism of END in patients with acute cerebral infarction have not yet been fully clarified,and there is no uniform diagnostic standard,and there is a lack of reliable prediction,evaluation indicators and preventive measures.Objective To explore the risk factors of END in patients with acute cerebral infarction.Methods A total of 3997 inpatients with acute cerebral infarction admitted to the Department of Neurology,Renqiu Kangji Xintu Hospital from January 2014 to November 2018 were selected as the research objects,including 136 cases with END(END group)and 3861 cases without END(non END group).The general data〔including gender,age,BMI,medical history(history of hypertension,diabetes,hyperlipidemia,cerebrovascular disease,atrial fibrillation,coronary heart disease),smoking,excessive drinking,antiplatelet drug use,cerebral infarction classification(TOAST classification),admission systolic blood pressure,admission diastolic blood pressure,NIHSS score〕,laboratory indicators(WBC,FPG,TC,TG,LDL-C,HDL-C,UA,FIB),color Doppler ultrasound examination results(occurrence of carotid plaque and carotid stenosis)of the patients were collected.The influencing factors of END in patients with acute cerebral infarction were analyzed by univariate and multivariate Logistic regression analysis.Results The age of END group was older than that of non END group,and admission systolic blood pressure,admission NIHSS score,FPG,TC,the incidence of carotid plaque,carotid stenosis were higher than those of the non END group(P<0.05).Multivariate Logistic regression analysis showed that age〔OR=1.025,95%CI(1.008,1.043)〕,admission systolic blood pressure〔OR=1.010,95%CI(1.004,1.017)〕,admission NIHSS score〔OR=1.048,95%CI(1.010,1.088)〕,TC〔OR=1.165,95%CI(1.010,1.344)〕,and carotid artery stenosis〔OR=1.669,95%CI(1.154,2.414)〕were independent influencing factors of END in patients with acute cerebral infarction(P<0.05).Conclusion Old age and elevated systolic blood pressure,NIHSS score and TC,and carotid artery stenosis are independent risk factors for END in patients with acute cerebral infarction.The related risk factors should be intervened early to reduce the disability rate of patients and improve their quality of life.