轻型缺血性卒中患者急性期神经功能恶化的影响因素

Influencing factors of acute neurological deterioration in patients with mild ischemic stroke

目的探讨轻型缺血性卒中(MIS)患者急性期神经功能恶化的影响因素。方法根据临床病情将249例急性MIS患者分为恶化组40例及未恶化组209例。比较两组患者的一般临床资料及血压变异性(BPV)参数。采用二元Logistic回归分析模型分析MIS患者急性期神经功能恶化的影响因素。结果恶化组与未恶化组同侧颅内动脉粥样硬化性狭窄、分水岭区脑梗死比率差异有统计学意义(均P<0.05)。与未恶化组相比,恶化组收缩压平均值(SBPm)、收缩压标准差(SBPsd)、收缩压变异系数(SBPcv)、收缩压最大最小差值(SBPmax-min)显著升高(均P<0.05)。多因素Logistic回归分析显示,SBPmax-min(OR=0.553,95%CI:0.315~0.969,P=0.039)是MIS患者发生急性期神经功能恶化的独立危险因素。SBPmax-min预测急性期神经功能恶化的ROC曲线下面积为0.832(95%CI:0.728~0.935,P=0.000),敏感度为69.0%,特异度为87.9%,约登指数为0.568,最佳截断值25.5。结论SBPmax-min是MIS急性期神经功能恶化的影响因素,对预测急性期神经功能恶化有较高的敏感度和特异度。

Objective To explore the influencing factors of acute neurological deterioration in patients with mild ischemic stroke(MIS).Methods According to the clinical condition,249 patients with acute MIS were divided into deterioration group(40 cases)and non⁃deterioration group(209 cases).The general clinical data and blood pressure variability(BPV)parameters were compared between the two groups.The binary Logistic regression analysis model was used to analyze the influencing factors of neurological deterioration in the acute phase of MIS patients.Results There were significant differences in the ratio of ipsilateral intracranial atherosclerotic stenosis and cerebral watershed infarction between the deterioration group and the non⁃deterioration group(all P<0.05).Compared with those in the non⁃deterioration group,the mean systolic blood pressure(SBPm),standard deviation of systolic blood pressure(SBPsd),coefficient of variation of systolic blood pressure(SBPcv)and maximum and minimum d⁃value of systolic blood pressure(SBPmax⁃min)in the deteriorating group were significantly higher(all P<0.05).Multivariate Logistic regression analysis showed that SBPmax⁃min(OR=0.553,95%CI:0.315-0.969,P=0.039)was an independent risk factor for neurological deterioration in the acute phase of MIS patients.The area under the ROC curve of SBPmax⁃min in predicting the neurological deterioration in the acute phase was 0.832(95%CI:0.728-0.935,P=0.000)with a sensitivity 69.0%and a specificity 87.9%,the Jordan index was 0.568,and the optimal cutoff value was 25.5.Conclusion SBPmax⁃min is the factor influencing neurological deterioration in the acute phase of MIS with high sensitivity and specificity.