拟诊急性缺血性脑卒中静脉溶栓治疗患者假卒中的分布特征分析

Characteristics of stroke mimics in patients with suspected acute ischemic stroke undergoing intravenous thrombolytic therapy

目的分析拟诊急性缺血性脑卒中(AIS)静脉溶栓治疗患者假卒中的分布特征。方法收集2018年1月至2020年1月嘉兴市第二医院卒中中心AIS静脉溶栓治疗患者269例的临床资料,经溶栓治疗后诊断AIS 240例(89.2%),假卒中29例(10.8%),比较两组患者的一般资料。溶栓治疗前采用美国国立卫生研究院卒中量表(NIHSS)评估患者的神经功能缺损程度,FABS评分表判别患者是否为假卒中,分析FABS<3分及≥3分患者在不同NIHSS评分分值段中的构成比,绘制假卒中发生率在NIHSS评分各分值段的散点图,并拟合假卒中分布的回归曲线,计算回归方程。结果AIS组患者的高血压、糖尿病、房颤患病率均高于假卒中组,差异均有统计学意义(均P<0.05)。FABS评分<3分及FABS评分≥3分的患者在NIHSS评分<6分、6~10分、>10分的3个分值段的构成比比较,差异有统计学意义(χ^(2)=18.72,P<0.05)。随着NIHSS评分值增大,实际频数及假卒中发生率降低。回归曲线的方程为lgY=47.68-0.32X(校正R^(2)=0.878,P<0.05)。结论假卒中发生率在急性脑血管病再灌注时间窗内NIHSS评分上符合递减指数曲线分布特点。

Objective To analyze the distribution characteristics of stroke mimics in patients with suspected acute ischemic stroke(AIS)treated with intravenous thrombolysis.Methods The clinical data of 269 patients with suspected AIS treated with intravenous thrombolysis in the stroke center of Jiaxing Second Hospital from January 2018 to January 2020 were retrospectively reviewed.After thrombolysis,240 patients(89.2%)were diagnosed as AIS and 29 patients(10.8%)were diagnosed as AIS mimic.The general data of the two groups were compared.Before thrombolysis,the National Institutes of Health stroke scale(NIHSS)was used to evaluate the degree of neurological deficit,and the FABS scoring system(F:facial droop,A:age and atrial fibrillation,B:blood pressure,S:seizures,sensory)was used to judge the mimic stroke.For thrombolytic patients,the constituent ratio of patients with FABS<3 and FABS≥3 in different NIHSS score segments was analyzed,the scatter diagram of stroke mimics rate in each score segment of NIHSS score was depicted,a regression curve of mimic stroke distribution was generated,and the regression equation was calculated.Results The prevalence of hypertension,diabetes and atrial fibrillation in AIS group was higher than those in AIS mimics group(P<0.05).There was significant difference in the constituent ratio of FABS<3 and FABS≥3 among patients with NIHSS score<6,6-10 and >10(χ^(2)=18.72,P<0.05).With the increase of NIHSS score,the actual frequency and stroke mimics rate decreased.The equation of regression curve was lgY=47.68-0.32X(corrected R^(2)=0.878,P<0.05).Conclusion The stroke mimics rate is in accordance with the distribution of index curve on NIHSS score in the reperfusion time window of acute cerebrovascular disease.