老年急性缺血性脑卒中静脉溶栓患者NIHSS评分与不良预后的相关性研究

Study on the correlation between NIHSS score and poor prognosis of elderly patients with acute ischemic stroke treated with intravenous thrombolysis

目的研究老年急性缺血性脑卒中静脉溶栓患者的NIHSS评分与预后的相关性。方法选取2019年1月-2021年6月在南京医科大学第一附属医院就诊的124例急性缺血性脑卒中患者,随访3个月,收集患者的基线临床资料。分别在入院时和阿替普酶(rt-PA)治疗后2 h、24 h、7 d和10 d时,对患者进行NIHSS评分。采用改良Rankin量表(mRS),评估患者3个月时的身体功能恢复情况,mRS得分为4~6定义为恢复不良。以Pearson相关分析基线临床资料连续性变量与NIHSS评分的相关性。通过Cox回归分析NIHSS评分与不良预后的相关性。结果恢复不良组入院时、rt-PA治疗后2h、4h、7d和10d的NIHSS评分均高于恢复较好组(P<0.001)。患者的年龄、糖尿病病史和房颤病史均与入院时的NIHSS评分呈显著的正相关性(r分别为0.38、0.13、0.26,P<0.05)。在充分校正年龄、糖尿病与房颤病史后在入院时、rt-PA治疗后2 h、4 h、7 d和10 d的NIHSS评分每增加1分,患者的mRS得分4~6的风险分别增加 59% (HR=1.59,95%CI:1.21 ~2.32,P<0.001)、63% (HR=1.63,95%CI:1.19~2.51,P<0.001)、72% (HR=1.72,95%CI:1.34~3.12,P<0.001)、80% (HR=1.80,95%CI:1.41 ~3.42,P<0.001)与 87% (HR=1.87,95%CI:1.25~3.55,P<0.001)。结论急性缺血性脑卒中静脉溶栓患者NIHSS评分与3个月时的恢复不良存在显著相关性。

Objective To study the correlation between NIHSS score and prognosis in elderly patients with acute ischemic stroke treated with intravenous thrombolysis.Methods 124 patients with acute ischemic stroke treated in the First Affiliated Hospital of Nanjing Medical University from January 2019 to June 2021 were selected.The patients were followed up for 3 months.Their baseline clinical data were collected.NIHSS scores of the patients were assessed at admission and 2 h,24 h,7 d and 10 d after treatment with alteplase(rt-PA).The modified Rankin Scale(mRS) was used to evaluate the recovery of physical function of the patients at 3 months.The mRS score of 4-6 was defined as the poor recovery.Pearson correlation analysis was used to analyze the correlation between the continuous variables of the baseline clinical data and the NIHSS score.The correlation between NIHSS score and poor prognosis was analyzed by Cox regression.Results The NIHSS scores of the poor recovery group at admission and 2 h,24 h,7 d and 10 d after treatment were higher than those of the good recovery group(P<0.001).The age,history of diabetes and history of atrial fibrillation were positively correlated with the NIHSS score at admission(r=0.38,0.13,0.26,P<0.05).After fully correcting age,history of diabetes and history of atrial fibrillation,for every 1 point increase in NIHSS scores at admission and 2 h,24 h,7 d and 10 d after rt-PA treatment,the risk of patients with mRS scores 4-6 increased by 59%(HR=1.59,95%CI:1.21-2.32,P<0.001),63%(HR=1.63,95%CI:1.19-2.51,P<0.001),72%(HR=1.72,95%CI:1.34-3.12,P<0.001),80%(HR=1.80,95%CI:1.41-3.42,P<0.001) and 87%(HR=1.87,95%CI:1.25-3.55,P<0.001),respectively.Conclusion There is a significant correlation between NIHSS score and poor recovery at 3 months in patients with acute ischemic stroke treated with intravenous thrombolysis.