首发颈动脉系统大面积脑梗死预后转归及相关因素分析

Analysis of prognosis and related factors in the first episode of massive cerebral infarction of carotid system

目的分析首发颈动脉系统大面积脑梗死预后转归及相关因素。方法选取2019年5月至2022年5月江苏省启东市人民医院神经内科收治的108例经颅脑CT/MRI确诊为首发颈动脉系统大面积脑梗死患者,采用改良Rankin量表(modified Rankin Scale,mRS)评估患者发病后3个月内预后情况(死亡或残疾),将患者分为预后良好(mRS评分<3分)组72例和预后不良(mRS评分≥3分)组36例。对影响两组患者预后的各项因素进行单因素分析和多因素Logistic回归分析,筛选出影响预后的独立危险因素。然后根据危险因素构建预测模型,并绘制ROC曲线评估其对预测首发颈动脉系统大面积脑梗死预后转归的预测价值。结果预后不良组患者老年、入院延迟时间、GCS评分、NIHSS评分、合并高血压、脑梗死面积、CT显示脑水肿症、CT显示出血性转化(HT)比例高于预后良好组,提示以上因素与首发颈动脉系统大面积脑梗死预后转归有关(P<0.05)。以预后不良为因变量,将有统计学意义的因素纳入多因素Logistic回归模型,结果显示,年龄60岁以上(OR=1.177,95%CI:1.071~1.293)、入院延迟时间高于3h(OR=1.143,95%CI:1.023~1.279)、合并高血压(OR=2.878,95%CI:1.281~6.465)、GCS评分高于12分(OR=1.283,95%CI:1.195~1.377)、NIHSS评分高于16分(OR=1.307,95%CI:1.202~1.422)是影响首发颈动脉系统大面积脑梗死预后转归的独立危险因素(P<0.05)。对Logistic回归分析筛选出的危险因素中最小β值对应的变量赋分为1,其他变量β值除以最小值后四舍五入取整数,获得整数分值后根据危险评分系统构建预测模型。评分越高,首发颈动脉系统大面积脑梗死预后不良风险越高。以各因素作为自变量,以预后不良为因变量(是=1,否=0),预测首发颈动脉系统大面积脑梗死预后转归的ROC曲线下面积为0.79(95%CI:0.746~0.832),此时的敏感度和特异度分别为82.35%和71.46%,Hosmer-Lemeshow拟合优度检验r=1.247,P=0.139。结论老年、入院延迟时间、合并高血压、GCS评分、NIHSS评分是影响首发颈动脉系统大面积脑梗死预后转归的独立危险因素,根据以上危险因素构建的预测模型对预测首发颈动脉系统大面积脑梗死预后不良具有较好预测价值。

Objective To explore and analyze the prognosis and related factors in the first episode of massive cerebral infarction of the carotid system.Methods 108 patients with first-episode carotid systemic large-area cerebral infarction admitted to the Department of Neurology,Qidong People's Hospital of Jiangsu Province from May 2019 to May 2022 were selected.The modified Rankin Scale(modified Rankin Scale,mRS)to evaluate the prognosis(death or disability)within 3 months after the onset of the disease,and divided the patients into a good prognosis(mRS score 3 points)group with 72 cases and a poor prognosis(mRS score≥3 points)group with 36 cases.Univariate analysis and multivariate Logistic regression analysis were performed on the factors affecting the prognosis of the two groups of patients,and the independent risk factors affecting the prognosis were screened out.Then,a predictive model was constructed according to the risk factors,and ROC curve was drawn to evaluate its predictive value in predicting the prognosis of the first episode of carotid system large-area cerebral infarction.Results The proportion of elderly patients,admission delay time,GCS score,NIHSS score,combined hypertension,cerebral infarction size,cerebral edema on CT,and hemorrhagic transformation(HT)on CT in the poor prognosis group was higher than that in the good prognosis group,suggesting that the above factors are related to the first episode of carotid artery system.The prognosis of large-area cerebral infarction was related to the prognosis(P<0.05).Taking poor prognosis as the dependent variable,and incorporating statistically significant factors into the multivariate Logistic regression model,the results showed that age over 60 years old(OR=1.177,95%CI:1.071-1.293)had higher admission delay time than 3 h(OR=1.143,95%CI.1.023-1.279),combined with hypertension(OR=2.878,95%CI.1.281-6.465),GCS score higher than 12points(OR=1.283,95%CI:1.195-1.377)and NIHSS score higher than 16 points(OR=1.307,95%CI:1.202-1.422)were independent risk factors affecting the prognosis of the first carotid system large-area cerebral infarction(P<0.05).Among the risk factors screened by Logistic regression analysis,the variable corresponding to the minimum β value was assigned a score of 1,and the β value of other variables was divided by the minimum value and rounded to an integer.After obtaining an integer score,a prediction model was constructed according to the risk scoring system.The higher the score,the higher the risk of poor prognosis in the first episode of massive cerebral infarction of the carotid system.With each factor as the independent variable and poor prognosis as the dependent variable(yes=1,no=0),the area under the ROC curve for predicting the prognosis of the first episode of massive cerebral infarction in the carotid system was 0.79(95%CI:0.746-0.832).the sensitivity and specificity were 82.35% and 71.46%,respectively,Hosmer-Lemeshow goodness of fit test r=1.247,P=0.139.Conclusion elderly,admission delay time,combined hypertension,GCS score,and NIHSS score are independent risk factors that affect the prognosis of first-episode carotid system large-area cerebral infarction.Poor prognosis of infarction has good predictive value.