基于倾向性评分匹配法评估急性缺血性脑卒中神经功能改善的影响因素分析

Analysis of the influencing factors of neurological improvement in acute ischemic stroke on the basis of propensity score matching

目的探讨急性缺血性脑卒中(AIS)患者神经功能改善的影响因素。方法选取上海市第十人民医院2019年6月-2020年6月首次缺血性卒中的247例患者为研究对象,根据出院时患者美国国立卫生研究院卒中量表(NIHSS)减少的百分率分为非显著提高组(<46%)和显著提高组(≥46%);使用1∶1倾向性评分匹配方法控制一般资料及入院NIHSS分值,对匹配后的患者采用logistic回归,研究神经功能改善的影响因素。结果匹配前,MBI(Z=2.030,P=0.042)、mRs(Z=2.996,P=0.003)、入院NIHSS评分(Z=2.501,P=0.012)、睡眠时长(χ^(2)=9.486,P=0.009)和认知障碍(χ^(2)=31.598,P<0.001)在2组间差异有统计学意义;匹配后,睡眠时长(χ^(2)=8.161,P=0.017)、糖尿病(χ^(2)=6.092,P=0.014)、认知障碍(χ^(2)=21.066,P<0.001)在2组间差异比较有统计学意义。将匹配后2组比较中P<0.1的变量(糖尿病、睡眠时长、认知障碍)纳入logistic回归分析,结果显示睡眠时长(OR=1.667,95%CI:1.043~2.664,P=0.033),MoCA(OR=4.697,95%CI:1.973~11.185,P<0.001)可能是影响神经功能改善的危险因素。结论睡眠时长越短、卒中后早期认知功能障碍对AIS短期预后有不利影响。

Objective To explore the factors influencing the improvement of neurological function in patients with acute ischemic stroke(AIS).Methods A total of 247 patients with first ischemic stroke from June 2019 to June 2020 in Shanghai Tenth People's Hospital were selected as the research objects,and the patients were divided into the non-significantly improved group(<46%)and significantly improved group(≥46%)according to the percentage reduction in National Institutes of Health Stroke Scale(NIHSS)at discharge.The 1∶1 propensity score matching method was used to control the general data of patients the admission NIHSS score,and logistic regression was used for matched patients to analyse the influencing factors of neurological function improvement.Results Before matching,MBI(Z=2.030,P=0.042),mRs(Z=2.996,P=0.003),admission NIHSS score(Z=2.501,P=0.012),sleep duration(χ^(2)=9.486,P=0.009)and cognitive impairment(χ^(2)=31.598,P<0.001)showed a statistically significant difference between both groups.After matching,sleep duration(χ^(2)=8.161,P=0.017),diabetes(χ^(2)=6.092,P=0.014)and cognitive impairment(χ^(2)=21.066,P<0.001)showed a statistically significant difference between both groups.After matching,the variables(diabetes,sleep duration,cognitive impairment)with P<0.1 in the comparison between both groups were entered into logistic regression analysis.Results showed that sleep duration(OR=1.667,95%CI:1.043-2.664,P=0.033)and MoCA(OR=4.697,95%CI:1.973-11.185,P<0.001)were risk factors affecting the improvement of neurological function.Conclusion Shorter sleep duration and early cognitive dysfunction after stroke have an adverse effect on the short-term prognosis of AIS.