急性孤立性脑桥梗死早期神经功能恶化的影响因素

Influencing Factors of Early Neurological Deterioration in Acute Isolated Pontine Infarction

目的探讨急性孤立性脑桥梗死早期神经功能恶化(END)的影响因素。方法回顾性收集2018年1月至2020年10月于郑州大学第一附属医院神经内科就诊的352例急性孤立性脑桥梗死患者的临床资料。使用美国国立卫生研究院卒中量表(NIHSS)评估患者入院时及入院后1周内每日的神经功能缺损严重程度。基于形态学的病因分类方法将脑桥梗死分为大动脉闭塞性疾病(LAOD)、基底动脉分支病变(BABD)和小动脉病(SAD)。根据发病后是否合并END将患者分为进展组(合并END)与非进展组(未合并END)。比较进展组和非进展组患者的临床资料。采用logistic回归分析预测急性孤立性脑桥梗死发生END的危险因素。结果进展组97例(27.6%),非进展组255例(72.4%)。进展组C反应蛋白(CRP)水平和入院时收缩压高于非进展组(P<0.05)。进展组与非进展组卒中亚型、梗死部位比较,差异有统计学意义(P<0.05)。卒中亚型、形态学部位、收缩压均为急性孤立性脑桥梗死发生END的影响因素(P<0.05)。与SAD相比,LAOD和BABD发生END的风险更高,且BABD发生END的风险高于LAOD;与上部梗死相比,中下部梗死更容易发生END,且下部梗死发生END的风险高于中部;收缩压高的患者容易发生END。结论LAOD或BABD、脑桥中下部梗死、收缩压高为急性孤立性脑桥梗死发生END的预测因素。

Objective To investigate the influencing factors of early neurological deterioration(END)in acute isolated pontine infarction.Methods The clinical data of 352 patients with acute isolated pontine infarction who were treated in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2020 were retrospectively collected.National Institutes of Health stroke scale(NIHSS)was used to assess the severity of neurological deficits at the time of admission and for 1 week after admission.Based on the etiology classification method of morphology,pontine infarction was divided into large artery occlusive disease(LAOD),basilar artery branch disease(BABD)and small artery disease(SAD).The patients were divided into progressive group(combined with END)and non-progressive group(without END)according to whether they were combined with END after the onset.The clinical data of patients in progressive group and non-progressive group were compared.Logistic regression analysis was used to predict the risk factors of END in acute isolated pontine infarction.Results There were 97 cases(27.6%)in progressive group and 255 cases(72.4%)in non-progressive group.The level of C reactive protein(CRP)and systolic blood pressure at admission in progressive group were higher than those in non-progressive group(P<0.05).There were statistical differences in the subtypes of stroke and infarct locations between progressive group and non-progressive group(P<0.05).The subtypes of stroke,infarct locations and systolic blood pressure were all influencing factors of END in acute isolated pontine infarction(P<0.05).Compared with SAD,LAOD and BABD had a higher risk of END,and BABD had a higher risk of END than LAOD.Compared with upper infarction,middle and lower infarcts were more prone to END,and the risk of END of lower infarcts was higher than that of middle infarcts.The patients with high systolic blood pressure were prone to END.Conclusion LAOD or BABD,middle and lower pontine infarction,and high systolic blood pressure are predictors of END in acute isolated pontine infarction.