急性大动脉粥样硬化性脑梗死患者早期神经功能恶化的危险因素分析

Risk factors of early neurological deterioration in patients with acute large artery atherosclerotic cerebral infarction

目的探讨急性大动脉粥样硬化(large artery atherosclerotic,LAA)性脑梗死患者早期神经功能恶化(early neurological deterioration,END)的危险因素。方法回顾性分析310例急性LAA性脑梗死患者,并将51例END患者设为试验组和259例非END患者设为对照组。比较2组患者的年龄、性别、高血压病史、糖尿病病史、血小板、糖化血红蛋白、总胆固醇(total cholesterol,TC)、三酰甘油、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、血清同型半胱氨酸(homocysteine,Hcy)、氯吡格雷抵抗(clopidogrel resistance,CR)发生率和细胞色素P4502C19(cytochrome P4502C19,CYP2C19)的单核苷酸多态性。用多因素Logistic回归分析急性LAA性脑梗死患者发生END的独立危险因素。结果试验组和对照组的Hcy分别为(16.80±10.74)和(12.69±6.52)μmol·L^(-1),血小板计数分别为(240.20±55.73)×10^(9)和(210.65±60.59)×10^(9)·L^(-1),TC分别为(4.90±1.26)和(4.33±0.97)mmol·L^(-1),LDL-C分别为(2.95±1.00)和(2.42±0.74)mmol·L^(-1),CR发生率分别为68.63%和47.49%,差异均有统计学意义(均P<0.05)。2组患者的年龄、性别、高血压病史、糖尿病病史、糖化血红蛋白、三酰甘油和HDL-C比较,差异均无统计学意义(均P>0.05)。进一步多因素Logistics回归分析显示:血小板计数、Hcy、LDL-C和CR是急性LAA性脑梗死患者发生END的独立危险因素。结论血小板计数、Hcy、LDL-C和CR是急性LAA性脑梗死患者END的独立危险因素。

Objective To analyze the risk factors of early neurological deterioration(END)in patients with acute large artery atherosclerotic(LAA)cerebral infarction.Methods A total of 310 patients with acute LAA cerebral infarction were retrospectively analyzed,and 51 patients with END were assigned to the treatment group and 259 patients without END were assigned to the control group.The age,gender,history of hypertension,diabetes history,platelets,glycosylated hemoglobin,total cholesterol(TC),triglycerides,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),serum homocysteine(Hcy),clopidogrel resistance(CR)and single nucleotide polymorphisms of cytochrome P4502 C19(CYP2C19)were compared between two groups.Multivariate Logistic regression was used to analyze the in dependent risk factors of END in patients with acute LAA cerebral infarction.Results The levels of Hcy in the treatment and control groups were(16.80±10.74)and(12.69±6.52)μmol·L^(-1),the platelet count were(240.20±55.73)×10^(9) and(210.65±60.59)×10^(9)·L^(-1),total cholesterol were(4.90±1.26)and(4.33±0.97)mmol·L^(-1),LDL-C were(2.95±1.00)and(2.42±0.74)mmol·L^(-1),incidences of CR were68.63% and 47.49%,the differences were statistically significant(allP<0.05).Age,gender,history of hypertension,history of diabetes,glycosylated hemoglobin,triglycerides and HDL-C had no statistically significant differences between the two groups(allP>0.05).Multivariate Logistic regression analysis showed that platelet count,Hcy,LDL-C and CR had significant differences.Conclusion Platelet count,Hcy,LDL-C and CR are independent risk factors for END in patients with acute LAA cerebral infarction.