急性缺血性卒中静脉溶栓患者短期预后的影响因素分析

Analysis of influencing factors of short-term prognosis of acute ischemic stroke patients with intravenous thrombolysis

目的探讨急性缺血性卒中静脉溶栓患者短期预后的影响因素。方法回顾性分析2018年10月至2021年1月在江苏省南通市第一人民医院接受静脉重组人组织纤维蛋白溶酶原激活剂治疗的患者318例,短期预后评价指标为发病3个月后改良Rankin量表评分,其中0~2分173例(预后良好组),≥3分145例(预后不良组)。对两组临床资料进行单因素及多因素分析,探讨短期预后的影响因素。结果预后不良组入院时美国国立卫生研究院卒中量表(NIHSS)评分、心房颤动占比、血糖/糖化血红蛋白比值(GAR)、空腹血糖、出血转化占比均高于预后良好组,尿酸水平、中性粒细胞数与淋巴细胞数比值均低于预后良好组,差异有统计学意义(P<0.05)。多因素分析显示,高入院时NIHSS评分、心房颤动、高GAR是急性缺血性卒中静脉溶栓患者短期预后不良的独立危险因素(OR>1,P<0.05),高尿酸是其保护因素(OR<1,P<0.05)。结论入院时NIHSS评分、GAR、心房颤动和尿酸水平均对急性缺血性卒中静脉溶栓患者短期预后有一定的影响。

Objective To investigate the influencing factors of short-term prognosis in acute ischemic stroke patients with intravenous thrombolysis.Methods A retrospective analysis was performed on 318 hospitalized patients who received intravenous recombinant human tissue plasminogen activator from October 2018 to January 2021 in the First People’s Hospital of Nantong,Jiangsu Province.Short-term prognostic index was modified Rankin scale score at three months after onset,including 0-2 scores in 173 cases(good prognosis group)and≥3 scores in 145 cases(poor prognosis group).Univariate and multivariate analysis were performed on the clinical data of the two groups to explore the influencing factors of short-term prognosis.Results The National Institutes of Health stroke scale(NIHSS)score at admission,proportion of atrial fibrillation,glucose to glycated haemoglobin ratio(GAR),fasting blood glucose,and proportion of hemorrhage conversion in the poor prognosis group were higher than those in the good prognosis group,the uric acid level and the neutrophil to lymphocyte ratio were lower than those in the good prognosis group,the differences were statistically significant(P<0.05).Multivariate analysis showed that high NIHSS score at admission,atrial fibrillation,and high GAR were independent risk factors for poor short-term prognosis in acute ischemic stroke patients with intravenous thrombolysis(OR>1,P<0.05),high uric acid was its protective factor(OR<1,P<0.05).Conclusion NIHSS score at admission,GAR,atrial fibrillation,and uric acid level have certain influence on short-term prognosis of acute ischemic stroke patients with intravenous thrombolysis.