轻中型急性缺血性脑卒中静脉溶栓后早期神经功能恶化的危险因素分析

Analysis on risk factors of early neurological deterioration after intravenous thrombolysis in mild to moderate acute ischemic stroke

目的探讨轻中型急性缺血性脑卒中(acute ischemic stroke,AIS)静脉溶栓后发生早期神经功能恶化(early neurological deterioration,END)的危险因素。方法收集2020年1月至2022年3月就诊于广西桂东人民医院神经内科的轻中型AIS接受静脉溶栓的患者193例,根据溶栓后是否发生END分为END组(n=41)和无END组(n=152),比较两组的一般资料、实验室指标和影像学结果,使用多因素logistic回归分析轻中型AIS静脉溶栓后发生END的危险因素,应用受试者工作特征(ROC)曲线分析多种危险因素联合对患者END的预测价值。结果与无END组相比,END组入院血糖、胆固醇、低密度脂蛋白、Fazekas评分、责任大血管狭窄比例更高(P<0.05),多因素logistic回归分析显示入院血糖(OR=0.890,95%CI:0.827~0.958,P=0.002)、Fazekas评分(OR=0.726,95%CI:0.544~0.969,P=0.030)、责任大血管狭窄(OR=0.270,95%CI:0.120~0.612,P=0.002)是预测END的独立危险因素。基于这三个危险因素构建ROC曲线,曲线下面积为0.807(95%CI:0.730~0.884,P<0.001),灵敏度为90.2%,特异度为62.5%。结论入院血糖、Fazekas评分、责任大血管狭窄可作为轻中型AIS静脉溶栓后发生END的独立预测因素,及早干预有利于患者的治疗。

Objective To explore the risk factors of early neurological deterioration(END)after intravenous thrombolysis in acute ischemic stroke(AIS).Methods From January 2020 to March 2022,193 cases of mild to moderate AIS patients receiving intravenous thrombolysis were collected from the Department of Neurology of Guidong People's Hospital of Guangxi Zhuang Autonomous Region.All patients were divided into END group(n=41)and non END group(n=152)according to whether END occurred after thrombolysis.And then,general data,laboratory indicators and imaging results of the two groups were compared,multivariate logistic regression analysis was used to analyze risk factors for END after intravenous thrombolysis in mild to moderate AIS.In addition,the predictive value of multiple risk factors combined on END in patients was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non END group,the proportion of blood glucose,cholesterol,low-density lipoprotein,Fazekas score,and responsible macrovascular stenosis was higher(P<0.05),multivariate logistic regression analysis showed that admission blood glucose(OR=0.890,95%CI:0.827-0.958,P=0.002),Fazekas score(OR=0.726,95%CI:0.544-0.969,P=0.030),and responsible macrovascular stenosis(OR=0.270,95%CI:0.120-0.612,P=0.002)were independent risk factors for predicting END.Based on these three risk factors,the ROC curve was constructed,and area under the curve was 0.807(95%CI:0.730-0.884,P<0.001),sensitivity was 90.2%,and specificity was 62.5%.Conclusion Admission blood glucose,Fazekas score,and responsible macrovascular stenosis can be used as independent predictors of END after intravenous thrombolysis among mild and medium AIS,and early intervention is beneficial to the treatment of patients.