青中年脑梗死预后一年情况调查及多因素回归分析

One-year prognosis survey and multivariate regression analysis of young and middle-aged cerebral infarction

目的 调查青中年脑梗死1年预后情况,并分析患者预后不良的有关影响因素,为临床干预提供参考。方法 选择芜湖市第二人民医院神经内科收治的2018年1月至2020年12月青中年脑梗死362例,依据1年预后情况,分为预后不良组(脑梗死复发、死亡或改良Rankin量表(mRS)≥3分)、预后良好组。收集两组一般资料,分析青中年脑梗死1年预后不良的影响因素,并创建Logistic回归预测模型,应用受试者工作特征(ROC)曲线评价模型预测价值。结果 经1年随访,本组362例青中年脑梗死患者失访6例,最终将356例患者纳入分析。356例患者中1年预后不良组48例,包括脑梗死复发17例,死亡5例,mRS≥3分26例;预后良好组308例。单因素分析显示,性别、年龄、糖尿病、高脂血症、冠心病、饮酒史、吸烟史、职业类型、C反应蛋白、葡萄糖、尿酸、尿素氮、血清肌酐、总胆红素、谷丙转氨酶、三酰甘油、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇均不是青中年脑梗死1年预后不良的重要影响因素(P> 0.05);高血压、同型半胱氨酸(Hcy)、白蛋白、美国国立卫生院卒中量表(NIHSS)评分、梗死面积均为青中年脑梗死1年预后不良的重要影响因素(P<0.05);Logistic回归分析发现,高血压、Hcy、NIHSS评分、梗死面积均为青中年脑梗死1年预后不良的独立危险因素,白蛋白为青中年脑梗死1年预后不良的保护因素(P<0.05);ROC曲线分析可知,Logistic回归模型预测青中年脑梗死1年预后不良的曲线下面积(AUC)为0.926,95%CI为0.894~0.951,P<0.001,敏感度87.50%,特异度为86.69%。结论 青中年脑梗死1年预后不良发生率较高,高血压、Hcy、NIHSS评分、梗死面积均为独立危险因素,白蛋白为青中年脑梗死1年预后不良的保护因素,应用上述因素构建的Logistic回归模型预测预后价值较高,可为预后预测提供重要依据。

Objective To investigate the one-year prognosis of cerebral infarction in young and middleaged patients,and to analyze the related influencing factors of poor prognosis of patients,so as to provide reference for clinical intervention.Methods 362 young and middle-aged patients with cerebral infarction treated in the Department of Nerrology,Wuhu Second People's Hospital from January 2018 to December 2020 were selected.According to the 1-year prognosis,they were divided into poor prognosis group(cerebral infarction recurrence,death or modified Rankin Scale(MRS)≥3 points)and good prognosis group.The general data of the two groups were collected to analyze the influencing factors of poor prognosis of young and middle-aged cerebral infarction in one year,and the Logistic regression prediction model was established.The prediction value of the model was evaluated by the receiver operating characteristic(ROC)curve.Results After 1-year follow-up,6 of 362 young and middle-aged cerebral infarction patients in this group were lost to follow-up,and 356 patients were finally included in the analysis.Among the 356 patients,48 patients were in the 1-year poor prognosis group,including 17 patients with recurrent cerebral infarction,5 patients died,and 26 patients with mRS≥3 points;308 patients in the good prognosis group.Univariate analysis showed that gender,age,diabetes,hyperlipidemia,coronary heart disease,drinking history,smoking history occupational type,C-reactive protein,glucose,uric acid,blood urea nitrogen,serum creatinine,total bilirubin,alanine aminotransferase,triacylglycerol,cholesterol,low-density lipoprotein cholesterol,and high-density lipoprotein cholesterol were not important influencing factors for poor 1-year prognosis of young and middle-aged cerebral infarction(P>0.05);Hypertension,Homocysteine(Hcy),albumin,National Institutes of Health Stroke Scale(NIHSS)score,and infarct size were all important influencing factors for poor 1-year prognosis of cerebral infarction in young and middleaged people(P<0.05);Logistic regression analysis showed that hypertension,Hcy,NIHSS score and infarct area were independent risk factors for poor prognosis of young and middle-aged cerebral infarction,and albumin was the protective factor for poor prognosis of young and middle-aged cerebral infarction(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the Logistic regression model for predicting poor 1-year prognosis of young and middle-aged cerebral infarction was 0.926,the 95%CI was 0.894-0.951,P<0.001,the sensitivity was 87.50%,and the specificity was 86.69%.Conclusion Young and middle-aged cerebral infarction has a higher incidence of poor prognosis at 1 year.Hypertension,Hcy,NIHSS score,and infarct size are all independent risk factors.Albumin is a protective factor for poor 1-year prognosis of young and middle-aged cerebral infarction.The Logistic regression model constructed with the above factors has a high predictive value and can provide an important basis for prognostic prediction.