急性轻型卒中相关前庭症状的临床特征及其持续存在的危险因素分析

Clinical Features and Risk Factors of Persistent Vestibular Symptoms Associated with Acute Mild Stroke

目的探讨急性轻型卒中患者出现卒中相关前庭症状的临床特征、演变规律,分析其持续存在的危险因素。方法前瞻性连续纳入2020年9月-2021年9月首都医科大学附属北京天坛医院神经病学中心发病7 d内,存在前庭症状的急性轻型(NIHSS<6分)卒中(包括缺血性卒中和脑出血)住院患者,收集基线人口学信息、症状、既往史、影像学信息、入院NIHSS、最终诊断等资料。入院时采用汉密尔顿焦虑量表和汉密尔顿抑郁量表评估患者有无焦虑和(或)抑郁状态。在住院期间不同时间点和发病后3个月连续随访患者的前庭症状演变情况,采用二元logistic回归分析卒中后3个月前庭症状持续存在的危险因素。结果最终纳入完成3个月随访的153例患者,平均年龄55.3±11.6岁,男性占85.0%(130/153)。发病时前庭症状以头晕最常见(137/153,89.5%),其次为姿势性症状(107/153,69.9%)和眩晕(67/153,43.8%),前庭-视觉症状最少见(15/153,9.8%),74.5%(114/153)合并有2种或以上前庭症状。卒中后2周50.3%(77/153)的患者前庭症状缓解。卒中后3个月随访时,43例(28.1%)仍存在前庭症状,110例(71.9%)前庭症状已缓解。有前庭症状的患者仍以头晕(38/43,88.4%)和姿势性症状(29/43,67.4%)为主,仅4.6%(2/43)的患者存在眩晕,所有患者均无前庭-视觉症状。单因素分析显示,卒中后3个月前庭症状持续组后循环近段卒中比例高于无前庭症状组(58.1%vs.32.7%,P=0.004)。二元logistic回归分析显示后循环近段卒中(OR 3.75,95%CI 1.71~8.25,P=0.001)和入院时NIHSS高(OR 1.35,95%CI 1.06~1.73,P=0.017)是患者发病后3个月前庭症状持续存在的独立危险因素。结论急性轻型卒中患者存在的卒中相关前庭症状以头晕和姿势性症状为主,常为多种症状共存。前庭症状短期恢复情况较好,后循环近段卒中和入院时NIHSS高是卒中后3个月前庭症状持续存在的独立危险因素。

Objective To describe the clinical features,evolution and risk factors of persistent vestibular symptoms related with acute mild stroke.Methods This study prospectively enrolled the consecutive inpatients with acute mild stroke(NIHSS<6)-related vestibular symptoms in Department of Neurology of Beijing Tiantan Hospital from September 2020 to September 2021.Baseline information were collected.At admission,the Hamilton anxiety scale and Hamilton depression scale were used to assess the patients'anxiety and/or depression.These patients were followed up from the hospitalization to 3 months after stroke onset to evaluate the evolution of vestibular symptoms.Binary logistic regression analysis was used to analyze the risk factors of persistent vestibular symptoms.Results A total of 153 patients were included in the final analysis,with a mean age of 55.3±11.6 years old and 130 males(85.0%).During stroke occurring,dizziness(137/153,89.5%)was the most common vestibular symptoms,followed by postural symptoms(107/153,69.9%),vertigo(67/153,43.8%)and vestibule-visual symptoms(15/153,9.8%).114 patients(74.5%)had two or more symptoms.The vestibular symptoms of 77 patients(50.3%)relieved 2 weeks after stroke onset.Only 43 patients(28.1%)still had vestibular symptoms at 3-month follow up,mainly manifested as dizziness(38/43,88.4%)and postural symptoms(29/43,67.4%);only 2 patients(4.6%)had dizziness,none of patients had vestibule-visual symptoms.Univariate analysis showed that the proportion of stroke in proximal posterior circulation was higher in the patients with vestibular symptoms 3 months after stroke than that in the patients without vestibular symptoms(58.1%vs.32.7%,P=0.004).After adjusting for the confounders,logistic regression analysis showed that stroke in proximal posterior circulation(OR 3.75,95%CI 1.71-8.25,P=0.001)and high baseline NIHSS score(OR 1.35,95%CI 1.06-1.73,P=0.017)were independent risk factors for persistent vestibular symptoms 3 months after stroke onset.Conclusions The acute mild stroke-related vestibular symptoms were mainly dizziness and postural symptoms,often with multiple symptoms coexisting.The vestibular symptoms recovered well in a short time.Stroke in proximal posterior circulation and high baseline NIHSS score were independent risk factors for persistent vestibular symptoms 3 months after stroke onset.