早期肌少症筛查对脑卒中患者预后康复的影响

The effect of early sarcopenia screening on the prognosis and rehabilitation of stroke patients

目的探讨早期肌少症筛查对于缺血性脑卒中患者预后康复效果的影响。方法选取河北中石油中心医院收治的缺血性脑卒中患者200例,根据是否伴有肌少症分为卒中伴肌少症组(100例)和脑卒中组(100例),比较2组四肢骨骼肌质量/身高、小腿围、体重指数(body mass index,BMI)、脑卒中后6个月患者的预后结局;并根据患者康复效果将其分为预后良好组(128例)和预后不良组(72例),对患者康复效果的影响因素采用Logistic数据模型进行分析。结果卒中伴肌少症组的四肢骨骼肌质量/身高、小腿围、BMI值均低于脑卒中组(P<0.05),卒中伴肌少症组的预后不良率高于脑卒中组(P<0.05),预后良好组入院时国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、入院时格拉斯哥昏迷(Glasgow Coma Scale,GCS)评分、平均动脉压变异性、合并高血压、合并糖尿病、合并心房颤动的情况与预后不良组比较(P<0.05),Logistic多因素分析,入院时NIHSS评分越高、入院时GCS评分越低、平均动脉压变异性越大、伴有心房颤动、肌少症是缺血性脑卒中患者预后不良的独立危险因素(P<0.05)。结论缺血性脑卒中患者伴有肌少症对于患者预后恢复不利,早期筛查患者是否伴有肌少症具有一定的临床价值。

Objective To explore the effect of early sarcopenia screening on the prognosis and rehabilitation of patients with ischemic stroke.Methods A total of 200 patients with ischemic stroke admitted to Hebei Petro China Central Hospital were selected and divided into stroke with sarcopenia group(n=100)and stroke group(n=100)according to presence of accompanied sarcopenia.Skeletal muscle mass/height,calf circumference,body mass index(BMI)and prognostic outcome at 6 months after stroke were compared between two groups.The patients were divided into good prognosis group(n=128)and poor prognosis group(n=72)according to the rehabilitation effect.The influencing factors of the rehabilitation effect of patients were analyzed by Logistic data model.Results The skeletal muscle mass/height,calf circumference and BMI of the stroke with myopenia group were lower than those of the stroke group(P<0.05),and the poor prognosis rate of the stroke with myopenia group was higher than that of the stroke group(P<0.05).The National Institute of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,mean arterial pressure variability,hypertension,diabetes,and atrial fibrillation at admission of the good prognosis group were compared with those of the poor prognosis group(P<0.05),Multivariate Logistic analysis showed that the higher the NIHSS score at admission,the lower the GCS score at admission,the greater the variability of mean arterial pressure,and the presence of atrial fibrillation and sarcopenia were independent risk factors for poor prognosis in ischemic stroke patients(P<0.05).Conclusion Sarcopenia in patients with ischemic stroke is unfavorable for prognosis and recovery of patients.Early screening of ischemic stroke patients with sarcopenia has certain clinical value.