急性脑梗死患者出院结局的相关因素分析

Discharge outcome-related factors in acute cerebral infarction patients

目的探讨急性脑梗死(ACI)患者出院结局的相关因素及白细胞计数(WBC)对不良出院结局的影响。方法选择2014年1月~2018年11月任丘康济新图医院神经内科住院的ACI患者4048例,按照患者出院时改良的Rankin量表(mRS)评分分为良好组(mRS 0~2分)3213例和不良组(mRS评分≥3分)835例,采用logistic回归分析出院结局的相关因素,分析入院时不同WBC水平[<4.0×10^(9)/L、(4.0~10.0)×10^(9)/L、(10.1~12.0)×10^(9)/L和>12.0×10^(9)/L]与出院结局不良的关系。结果2组男性、年龄、糖尿病、高脂血症、脑卒中史、心房颤动、冠心病、吸烟、过量饮酒、使用抗血小板药物比例、收缩压、舒张压、美国国立卫生研究院卒中量表(NIHSS)评分、纤维蛋白原、FPG、TG、LDL-C、脂蛋白a、同型半胱氨酸、尿酸和胱抑素C水平比较,差异有统计学意义(P<0.05,P<0.01)。良好组较不良组WBC水平明显降低,差异有统计学意义[6.59(5.47,8.00)×10^(9)/L vs 6.96(5.73,8.44)×10^(9),P=0.000];多因素logistic回归分析显示,年龄(OR=1.031,95%CI:1.017~1.045,P<0.01)、吸烟(OR=1.398,95%CI:1.062~1.841,P<0.05)和NIHSS评分(OR=2.422,95%CI:2.263~2.592,P<0.01)是ACI患者出院结局不良的独立危险因素;以WBC(4.0~10.0)×10^(9)/L为参照,WBC(10.1~12.0)×10^(9)/L(OR=1.660,95%CI:1.020~2.701,P<0.05),WBC>12.0×10^(9)/L(OR=2.545,95%CI:1.395~4.642,P<0.01)有增加患者出院结局不良的风险。结论ACI患者出院结局不良与年龄、吸烟、NIHSS评分和WBC密切相关,WBC水平越高,患者出现出院结局不良的风险越高。

Objective To study the discharge outcome-related factors and the effect of WBC count on poor discharge outcome in ACI patients.Methods A total of 4048 ACI patients admitted to our hospital from November 2018 to January 2014 were divided into good discharge outcome group(n=3213)and poor discharge outcome group(n=835)according to their mRS score.The discharge outcome-related factors and the relationship between WBC count on admission and poor discharge outcome in ACI patients were analyzed by multivariate logistic regression analysis.Results The WBC count was significantly different in two groups(P<0.01).Multivariate logistic regression analysis showed that age,smoking and NIHSS score were the independent risk factors for poor discharge outcome in ACI patients(OR=1.031,95%CI:1.017-1.045,P<0.01;OR=1.398,95%CI:1.0621.841,P<0.05;OR=2.422,95%CI:2.263-2.592,P<0.01).WBC count=(10.1-12.0)×10^(9)/L and WBC count>12.0×10^(9)/L were the risk factors for poor discharge outcome in ACI patients when the WBC count=(4.0-10.0)×10^(9)/L was used as a reference(OR=1.660,95%CI:1.020-2.701,P<0.05;OR=2.545,95%CI:1.3954.642,P<0.01).Conclusion The poor discharge outcome is closely related with age,smoking,NIHSS score and the greater the WBC count is,the poorer the discharge outcome is in ACI patients.