大动脉粥样硬化型急性脑梗死患者预后的相关危险因素研究

Study of risk factors associated with prognosis in patients with aortic acute cerebral infarction

目的探究大动脉粥样硬化型急性脑梗死患者3个月预后的相关危险因素。方法选取2018年6月至2019年12月于河北大学附属医院神经内科就诊的大动脉粥样硬化型急性脑梗死患者191例进行前瞻性研究,根据患者3个月预后改良Rankin量表评分将患者分为预后良好组(153例)和预后不良组(38例),对两组患者之间的一般资料、既往病史和血压变异性(blood pressure variability,BPV)评价指标进行相关性分析,符合正态分布的计量资料组间比较采用t检验;计数资料组间比较采用χ2检验。采用Logistic进行危险因素分析。结果预后不良组患者糖尿病病史比例[20.3%(31/153)]、入院美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分[(3.03±2.01)分]、24 h收缩压血压标准差(standard deviation,SD)[(12.06±4.46)mmHg]和24 h收缩压血压变异系数(coefficient of variation,CV)[(8.61±3.08)%]低于预后良好组[47.4%(18/38)、(5.61±3.84)分、(14.75±3.46)mmHg、(10.41±2.18)%],差异均有统计学意义(统计量值分别为χ2=11.73、t=4.01、t=3.46、t=3.38;P值分别为0.001、<0.001、0.001、0.001)。因24 h收缩压SD与24 h收缩压CV存在明显的共线性,故分别将其纳入Logistic回归模型中,将糖尿病病史、入院NIHSS评分和24 h收缩压SD纳入自变量,急性脑梗死患者预后不良危险因素的多因素Logistic回归结果显示:糖尿病病史(OR=3.649,95%CI:1.545~8.648,P=0.003)、入院NIHSS评分(OR=1.472,95%CI:1.247~1.725,P<0.001)和24 h收缩压SD(OR=1.201,95%CI:1.085~1.336,P<0.001);将糖尿病病史、入院NIHSS评分和24 h收缩压CV纳入自变量,急性脑梗死患者预后不良危险因素的多因素Logistic回归结果显示:糖尿病病史(OR=4.695,95%CI:1.873~11.766,P=0.001)、入院NIHSS评分(OR=1.922,95%CI:1.513~2.441,P<0.001)和24 h收缩压CV(OR=1.220,95%CI:1.045~1.425,P=0.012)均是影响患者预后评价的独立危险因素。结论24 h收缩压SD和24 h收缩压CV较平均血压值对患者预后的影响在临床预测中更具价值,且控制糖尿病患者血糖水平对脑梗死患者的预后价值较高。

Objective To explore the risk factors associated with a three-month prognosis in patients with aortic acute cerebral infarction.Methods A prospective study was conducted on 191 patients with aorthropathic acute cerebral infarction included in the Department of Neurology from June 2018 to December 2019,and the patients were divided into good prognosis group(153 cases)and poor prognosis group(38 cases)according to the MRS score of the patient's 3-month prognosis,and the general data,past medical history and blood pressure variability evaluation index(BPV)between the two groups were correlated analysis.The t-test was used to compare the measurement data with normal distribution,theχ^(2)test was used to compare the counting data,and the Logistic regression analysis was used to analyze the risk factors.Results The proportion of patients with diabetes history in the poor prognosis group(20.3%(31/153)),admission NIHSS score((3.03±2.01)points),standard deviation(SD)((12.06±4.46)mmHg)and coefficient of variation(CV)((8.61±3.08)%)of systolic blood pressure at 24 h were lower than those in the good prognosis group(47.4%(18/38),(5.61±3.84)points,(14.75±3.46)mmHg,(10.41±2.18)%),the differences were statistically significant(the statistical values wereχ^(2)=11.73,t=4.01,t=3.46,t=3.38;P values were 0.001,<0.001,0.001,and 0.001,respectively).Because 24 h systolic blood pressure SD and 24 h systolic blood pressure CV had obvious collinearity,they were respectively included in the Logistic regression model.Taking diabetes history,NIHSS score and 24 h systolic blood pressure SD into the variables,the multivariate Logistic regression results of adverse prognostic risk factors in patients with acute cerebral infarction showed that the history of diabetes mellitus(OR=3.649,95%CI:1.545-8.648,P=0.003),NIHSS score(OR=1.472,95%CI:1.247-1.725,P<0.001)and 24 h systolic blood pressure SD(OR=1.201,95%CI:1.085-1.336,P<0.001).Taking diabetes history,NIHSS score and 24 h systolic blood pressure CV into consideration,multivariate Logistic regression results of adverse prognostic risk factors in patients with acute cerebral infarction showed that the history of diabetes mellitus(OR=4.695,95%CI:1.873-11.766,P=0.001),admission NIHSS score(OR=1.922,95%CI:1.513-2.441,P<0.001)and 24 h systolic blood pressure CV(OR=1.220,95%CI:1.045-1.425,P=0.012).All are independent risk factors influencing the prognosis of patients.Conclusion The effect of 24 h systolic blood pressure SD and 24 h systolic blood pressure CV on patient prognosis was more valuable in clinical prediction,and the prognosis value of controlling blood glucose levels in patients with diabetes was higher in patients with cerebral infarction.