非致残性缺血性脑血管事件患者神经功能缺损加重的危险因素分析

Analysis of risk factors for aggravated neurological deficit in patients with non-disabling ischemic cerebrovascular events

目的探讨非致残性缺血性脑血管事件(NICE)患者神经功能缺损加重的危险因素。方法选取保定市第一中心医院2019-01—2020-12收治的156例NICE患者,测定患者发病1周内美国国立卫生研究院卒中量表(NIHSS)评分,将NIHSS评分较发病时基线水平增加≥2分的患者纳入加重组,将NIHSS评分较发病时基线水平增加<2分的患者纳入非加重组。收集患者基线资料、影像学指标及并发症发生情况,并进行单因素分析,将单因素分析有统计学意义的指标纳入多因素Logistic回归分析,寻找NICE患者发病1周后神经功能缺损加重的危险因素。结果加重组的年龄、合并糖尿病、合并冠心病、ABCD~3-Ⅰ评分、新发缺血性脑卒中、责任动脉狭窄或闭塞、多发病灶、脑室旁白质高信号(PVH)评分、脑白质高信号(WMH)总负荷、住院期间合并急性感染、新发缺血性脑卒中水平与非加重组比较有显著差异(P<0.05);2组性别、吸烟史、饮酒史、家族史、缺血性脑卒中/TIA史、高血压、高血脂、病灶部位、深部脑白质高信号(DWMH)评分、收缩压(SBP)、舒张压(DBP)、尿酸水平以及药物治疗情况比较无显著差异(P>0.05)。经多因素Logistic回归分析显示,年龄≥70岁(OR=1.419,95%CI:1.119~3.417,P=0.001)、糖尿病(OR=2.319,95%CI:1.506~3.021,P=0.012)、责任动脉狭窄或闭塞(OR=4.099,95%CI:1.528~6.575,P=0.000)、合并急性感染(OR=1.369,95%CI:1.143~3.581,P=0.001)、新发缺血性脑卒中(OR=2.013,95%CI:1.143~3.581,P=0.001)、ABCD~3-Ⅰ评分8~13分(OR=3.511,95%CI:1.526~3.413,P=0.000)、PVH评分2~3分(OR=1.731,95%CI:1.072~3.719,P=0.017)以及WMH总负荷3~6分(OR=3.421,95%CI:1.589~3.213,P=0.002)为NICE患者发病1周内神经功能缺损加重的独立危险因素。结论NICE患者发病1周内神经功能缺损加重与高龄、糖尿病、责任动脉狭窄或闭塞、ABCD~3-Ⅰ评分、PVH评分、WMH总负荷、急性感染以及新发缺血性脑卒中密切相关。

Objective To explore the risk factors for the aggravation of neurological deficits in patients with non-disabling ischemic cerebrovascular events(NICE).Methods Totally 156 NICE patients admitted to Baoding First Central Hospital from January 2019 to December 2020 were selected,and the National Institutes of Health stroke scale(NIHSS)scores within 1 week of the onset of the patients were measured.Patients whose NIHSS score increased by≥2 points from the baseline level at the onset of the disease were included in the additive group,and patients whose NIHSS score increased by less than 2 points from the baseline level at the onset of the disease were included in the non-additive group.The baseline data,imaging indicators,and complications were collected,and conduct univariate analysis,include statistically significant indicators of univariate analysis into multivariate Logisti regression analysis,and look for the risk factors of neurological deficit aggravated one week after the onset of NICE patients.Results Additive group age,combined diabetes,combined coronary heart disease,ABCD 3-Ⅰscore,new ischemic stroke,responsible artery stenosis or occlusion,multiple foci,periventricular hyperintensity(PVH)score,white matter hyperintensity(WMH)total load,combined during hospitalization The levels of acute infections and new ischemic strokes were significantly different from those of non-additive groups(P<0.05).The gender,smoking history,drinking history,family history,ischemic stroke/TIA history,hypertension,hyperlipidemia,lesion location,deep white matter hyperintensity(DWMH)score,systolic blood pressure(SBP),diastolic blood pressure(DBP),the level of uric acid and drug treatment of two groups were not significantly different(P>0.05).Multivariate logistic regression analysis showed that age≥70 years old(OR=1.419,95%CI:1.119-3.417,P=0.001),diabetes(OR=2.319,95%CI:1.506-3.021,P=0.012),responsibility arterial stenosis or occlusion(OR=4.099,95%CI:1.528-6.575,P=0.000),acute infection(OR=1.369,95%CI:1.143-3.581,P=0.001),new ischemic stroke(OR=2.013,95%CI:1.143-3.581,P=0.001),ABCD 3-Ⅰscore of 8-13(OR=3.511,95%CI:1.526-3.413,P=0.000),PVH score of 2-3(OR=1.731,95%CI:1.072-3.719,P=0.017)and the total WMH load of 3-6 points(OR=3.421,95%CI:1.589-3.213,P=0.002)were NICE patients onset for 1 week independent risk factors for aggravation of internal neurological deficits.Conclusion The worsening of neurological deficits in NICE patients within 1 week of onset is closely related to advanced age,diabetes,responsible artery stenosis or occlusion,ABCD 3-Ⅰscore,PVH score,total WMH load,acute infection and new ischemic stroke.