轻型后循环脑梗死患者早期临床恶化的影响因素

Influencing factors for early clinical deterioration in patients with mild posterior circulation infarction

目的探索轻型后循环脑梗死患者在发病早期出现临床病情恶化的发生率及其影响因素。方法回顾性纳入2016年1月1日至2020年1月1日期间就诊的291例轻型后循环脑梗死患者。以急性期临床病情恶化(clinical deterioration within 24 h,CD24h)和亚急性期临床病情恶化(clinical deterioration between 2 d and 14 d,CD14d)为主要终点事件。数据统计使用IBM SPSS Statistics 19.0软件,应用Pearson Chi-Square检验或Mann-Whitney U检验比较相应变量的组间差异,使用多变量Logistic回归模型分析主要终点指标的影响因素。结果主要终点事件CD24h和CD14d的发生率分别为21.6%(63/291)和30.6%(89/291),接受再灌注治疗的患者比例为13.4%(39/291)。以CD24h为终点事件的多变量Logistic回归分析模型结果显示:基线美国国立卫生院神经功能缺损评分(NIHSS)高是增加CD24h风险的正性独立影响因素(OR=1.184;95%CI=1.078~1.300;P<0.01);小脑梗死(相比脑干梗死)(OR=0.250;95%CI=0.082~0.757;P=0.014)、非大动脉粥样硬化(相比大动脉粥样硬化)(OR=0.026;95%CI=0.002~0.325;P=0.005)对CD24h有负性预测作用。以CD14d为终点事件的多变量Logistic回归分析结果提示:肺部感染(OR=28.085;95%CI=6.863~114.927;P<0.01)和基线NIHSS高(OR=1.114;95%CI=1.001~1.240;P=0.048)是增加CD14d风险的独立影响因素,而再灌注治疗(OR=0.089;95%CI=0.013~0.613,P=0.014)可降低CD14d风险;基底动脉尖部综合征(相比脑干梗死)(OR=7.526;95%CI=1.565~36.188;P=0.012)增加CD14d发生风险,而非大动脉粥样硬化(相比大动脉粥样硬化)(OR=0.076;95%CI=0.009~0.683;P=0.021)对CD14d的发生风险有负性预测作用。基线NIHSS(OR=0.834;95%CI=0.758~0.918;P<0.01),CD14d(OR=0.048;95%CI=0.018~0.130;P<0.01)和肺部感染(OR=0.045;95%CI=0.012~0.167;P<0.01)对良好临床预后(发病14 d的改良Rankin评分≤2)有负性预测作用。结论早期临床病情恶化对轻型后循环脑梗死良好临床预后有负性预测作用。大动脉粥样硬化狭窄亚型和基底动脉尖部综合征是轻型后循环脑梗死患者CD24h和CD14d的危险因素,肺部感染是CD14d的危险因素。急性期再灌注治疗有助于降低轻型后循环脑梗死患者早期临床恶化风险和改善临床预后。

Objective To study the incidence and influencing factors for clinical deterioration at an early stage in patients with mild posterior circulation infarction(PCI).Methods Totally 291 patients with mild PCI from January 1,2016 to January 1,2020 were retrospectively included.Clinical deterioration within 24 h(CD24h)and clinical deterioration between 2 d and 14 d(CD14d)were the endpoint events.IBM SPSS Statistics 19.0 software was used for statistical analysis.Pearson chi-square test or Mann-Whitney U test were used to compare the group differences of corresponding variables.Multivariate logistic regression model was used to analyze the influencing factors of the primary endpoint events.Results The incidences of CD24h and CD14d were 21.6%(63/291)and 30.6%(89/291)respectively,with the reperfusion therapy rate of 13.4%(39/291).The results of multivariate logistic regression analysis with CD24h as the endpoint event showed that the baseline NIHSS was a positive independent factor increasing the risk of CD24h(OR=1.184,95%CI=1.078-1.300,P<0.01).Cerebellar infarction(compared with brainstem infarction)(OR=0.250,95%CI=0.082-0.757,P=0.014)and non-macroatherosclerosis(compared with major atherosclerosis)(OR=0.026,95%CI=0.002-0.325,P=0.005)had negative predictive effects on CD24h.The results of multivariate logistic regression analysis with CD14d as the endpoint event showed that pulmonary infection complications after stroke(OR=28.085,95%CI=6.863-114.927,P<0.01)and baseline NIHSS(OR=1.114,95%CI=1.001-1.240,P=0.048)were independent factors of CD14d.Reperfusion therapy(OR=0.089,95%CI=0.013-0.613,P=0.014)could reduce the risk of CD14d.Top of basilar syndrome(compared with single brainstem infarction)(OR=7.526,95%CI=1.565-36.188,P=0.012)increased the risk of CD14d,while the non-macroatherosclerotic(compared with the macroatherosclerotic subtype)(OR=0.076,95%CI=0.009-0.683,P=0.021)negatively predicted the risk of CD14d.Baseline NIHSS(OR=0.834,95%CI=0.758-0.918,P<0.01),CD14d(OR=0.048,95%CI=0.018-0.130,P<0.01)and pulmonary infection complications(OR=0.045,95%CI=0.012-0.167,P<0.01)were negatively predicted the good clinical prognosis(modified Rankin score 14 days after onset≤2).Conclusion Early clinical deterioration has a negative predictive effect on clinical prognosis improvement of patients with mild PCI.Large artery atherosclerotic stenosis subtype and basilar apex syndrome are the risk factors of CD24h and CD14d of patients with mild PCI,and pulmonary infection is the risk factor of CD14d.Reperfusion therapy in acute phase is helpful to reduce the risk of early clinical deterioration and improve clinical prognosis in patients with mild PCI.