老年急性前循环脑梗死病人静脉溶栓预后不良的危险因素及预测价值

Risk factors of poor prognosis in elderly patients with acute anterior circulation cerebral infarction undergoing intravenous thrombolysis

目的探讨老年急性前循环脑梗死(AACI)病人静脉溶栓预后不良的危险因素及预测价值。方法纳入2019年1月至2021年5月在我院接受阿替普酶静脉溶栓治疗的老年AACI病人共106例,根据3个月后改良的Rankin量表(mRS)评分结果分为预后良好组58例(0~2分)及预后不良组48例(3~6分),回顾性分析2组临床资料,采用Logistic回归模型分析预后不良的影响因素,并通过ROC曲线评估相关因素对预后的预测价值。结果2组间年龄、心房颤动、中性粒细胞与淋巴细胞比值(NLR)、活化部分凝血活酶时间(APTT)、磁共振弥散加权成像Alberta卒中项目早期CT评分(DWI-ASPECTS)、血栓负荷评分(CBS)、侧支循环Tan评分、NIHSS评分以及早期神经功能恶化(END)发生率差异均有统计学意义(P<0.05);多因素Logistic回归分析提示NLR(OR=1.426,95%CI:1.023~1.989,P=0.036)、基线NIHSS评分(OR=1.144,95%CI:1.020~1.284,P=0.022)以及END(OR=25.818,95%CI:2.523~264.182,P=0.006)是预后不良的独立危险因素,侧支循环Tan评分(OR=0.249,95%CI:0.115~0.540,P<0.001)是预后不良的独立保护因素。ROC曲线分析表明NLR、侧支循环Tan评分、基线NIHSS评分及END预测预后的AUC分别为0.657、0.832、0.743及0.681。结论老年AACI病人静脉溶栓预后不良的危险因素众多,溶栓前的NLR、侧支循环Tan评分,基线NIHSS评分及END对病人预后具有良好的预测价值。

Objective To investigate the risk factors of poor prognosis in the elderly patients with acute anterior circulation cerebral infarction(AACI)undergoing intravenous thrombolysis.Methods A total of 106 elderly patients with AACI who received intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)in our hospital from January 2019 to May 2021 were enrolled.According to the score of modified Rankin scale(mRS)3 months after the treatment,they were divided into good prognosis group(58 cases)(0-2 points)and poor prognosis group(48 cases)(3-6 points).The clinical data of the two groups were retrospectively analyzed.Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the related factors for poor prognosis.Results Age,the incidence rate of atrial fibrillation,neutrophil to lymphocyte ratio(NLR),activated partial thromboplastin time(APTT),Alberta stroke program early CT score(DWI-Aspects),clot burden score(CBS),collateral circulation Tan score,baseline NIHSS score,and the incidence rate of early neurological deterioration(END)were significantly different between the two groups(P<0.05).Multivariate Logistic regression analysis suggested NLR(OR=1.426,95%CI:1.023-1.989,P=0.036),baseline NIHSS score(OR=1.144,95%CI:1.020-1.284,P=0.022)and END(OR=25.818,95%CI:2.523-264.182,P=0.006)were the independent risk factors,while collateral circulation Tan score(OR=0.249,95%CI:0.115-0.540,P<0.001)was a protective factor of poor prognosis.ROC curve analysis showed that the area under curve(AUC)of NLR,collateral circulation Tan score,baseline NIHSS score and END for predicting prognosis was 0.657,0.832,0.743 and 0.681 respectively.Conclusions There are many risk factors for poor prognosis in the elderly patients with AACI after intravenous thrombolysis.NLR,Tan score of collateral circulation,baseline NIHSS score and END before thrombolysis show good predictive value for prognosis.