孤立性皮质下梗死患者早期神经功能恶化的危险因素分析

Analysis of risk factors for early neurological deterioration in patients with isolated subcortical infarction

目的 分析孤立性皮质下梗死患者发生早期神经功能恶化(END)的相关危险因素。方法 选取2021年1月至2022年3月在河北省沧州市中心医院神经内科住院治疗的422例经颅脑核磁检查确定为孤立性皮质下梗死的患者作为研究对象。在入院当天及之后的3 d内利用美国国立卫生研究院卒中量表(NIHSS)评分评估所有患者的神经功能缺损程度,若入院后72 h内NIHSS评分增加≥2分,称其发生了END。依据是否发生END将患者分为END组(81例)和非END组(341例)。比较两组患者的一般资料及危险因素,最后筛选预测END的独立危险因素。结果 两组年龄、男性比例、卒中史、病灶直径、载体动脉狭窄比较,差异有统计学意义(P<0.05)。logistic回归分析显示,男性(OR=3.084,95%CI:1.500~6.340,P=0.002)、卒中史(OR=2.391,95%CI:1.158~4.937,P=0.018)、病灶直径>2.0 cm (OR=3.038,95%CI:1.434~6.436,P=0.004)、载体动脉狭窄(OR=14.157,95%CI:7.602~26.363,P<0.001)是急性孤立性皮质下梗死患者发生END的独立危险因素。结论 男性、有卒中史、病灶直径>2.0 cm、合并载体动脉狭窄的孤立性皮质下梗死患者更易发生END,应引起临床上的关注。

Objective To analyze the risk factors for early neurological deterioration(END)in patients with isolated subcortical infarction.Methods A total of 422 patients who were hospitalized in the Department of Neurology of Cangzhou Central Hospital from January 2021 to March 2022 and diagnosed as isolated subcortical infarction by MRI were selected as the research objects.National Institutes of Health stroke scale(NIHSS)score was used to assess the degree of neurological impairment of all patients on the day of admission and within three days after admission.If the NIHSS score increased≥2 points within 72 hours after admission,it was considered that END had occurred.Then,patients were divided into the END group(81 cases)and the non-END group(341 cases)according to whether END occurred.Baseline data and risk factors of the two groups were compared,and the independent risk factors for predicting END were screened out.Results There were significant differences in age,male ratio,stroke history,lesion diameter,and carrier artery stenosis between the two groups(P<0.05).Logistic regression analysis showed that male(OR=3.084,95%CI:1.500-6.340,P=0.002),stroke history(OR=2.391,95%CI:1.158-4.937,P=0.018),lesion diameter>2 cm(OR=3.038,95%CI:1.434-6.436,P=0.004)and carrier artery stenosis(OR=14.157,95%CI:7.602-26.363,P<0.001)were independent risk factors for END in patients with acute isolated subcortical infarction.Conclusion Isolated subcortical infarction patients with male,stroke history,lesion diameter>2.0 cm,and carrier artery stenosis are more likely to develop END,which should arouse clinical attention.