轻型缺血性卒中功能预后影响因素的Meta分析

Meta-analysis of factors influencing the prognosis of mild ischemic stroke function

目的 通过系统评价的方法分析轻型缺血性卒中功能预后的影响因素,为轻型缺血性卒中患者功能预后的干预措施提供证据支持。方法 检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science和Cochrane Library,检索自建库至2023年2月有关轻型缺血性卒中功能预后影响因素的队列研究和病例对照研究。由2名研究者独立筛选文献、提取资料并对纳入研究进行质量评价后,采用Rev Man5.3软件进行Meta分析。结果 共纳入17项研究,包括15项前瞻性队列研究和2项回顾性队列研究,共17 933例患者。Meta分析显示,年龄(MD=6.59,95%CI:5.41, 7.77)、糖尿病(OR=1.90,95%CI:1.53, 2.37)、大动脉粥样硬化性卒中(OR=2.62,95%CI:1.68, 4.08)、卒中史(OR=1.71,95%CI:1.54, 1.89)、入院时美国国立卫生院神经功能缺损(NIHSS)评分(OR=1.41,95%CI:1.24, 1.60)、颅内大血管狭窄或闭塞(OR=6.29,95%CI:4.31, 9.18)、急性期神经功能恶化(OR=13.41,95%CI:5.54, 32.42)、并发肺炎(OR=4.45,95%CI:3.49, 5.68)、高血压(OR=1.51,95%CI:1.18, 1.95)、心源性脑栓塞(OR=2.29,95%CI:1.47, 3.55)是轻型缺血性卒中功能预后的影响因素(P<0.05)。结论年龄、糖尿病、大动脉粥样硬化性卒中、卒中史、入院时NIHSS评分、颅内大血管狭窄或闭塞、急性期神经功能恶化、并发肺炎、高血压、心源性脑栓塞是轻型缺血性卒中功能预后的影响因素。对有以上影响因素的轻型缺血性卒中患者应早期识别并针对性地采取干预措施,以改善轻型缺血性卒中患者的临床预后。

Objective To analyze the influencing factors of functional prognosis in mild ischemic stroke patients through a systematic evaluation method,and provide evidence support for intervention measures for functional prognosis in mild ischemic stroke patients.Methods We searched the China National Knowledge Infrastructure,Wanfang Database,VIP Database,China Biomedical Literature Service Database,PubMed,Embase,Web of Science and Cochrane Library for cohort studies and case-control studies on factors affecting the prognosis of mild ischemic stroke function from the establishment of the library to February 2023.After two researchers independently selected literature,extracted data,and evaluated the quality of the included studies,Meta-analysis was conducted using RevMan5.3 software.Results A total of 17 studies were included,including 15 prospective cohort studies and 2 retrospective cohort studies,with a total of 17,933 patients.The Meta-analysis showed that the age(MD=6.59,95%CI:5.41,7.77),diabetes mellitus(MD=1.90,95%CI:1.53,2.37),major atherosclerotic stroke(MD=2.62,95%CI:1.68,4.08),stroke history(MD=1.71,95%CI:1.54,1.89),National Institutes of Health stroke scale(NIHSS)score at admission(MD=1.41,95%CI:1.24,1.60),intracranial large vessel stenosis or occlusion(OR=6.29,95%CI:4.31,9.18),acute neurological deterioration(OR=13.41,95%CI:5.54,32.42),pneumonia(OR=4.45,95%CI:3.49,5.68),hypertension(OR=1.51,95%CI:1.18,1.95),cardiogenic cerebral embolism(OR=2.29,95%CI:1.47,3.55)were the influential factors for functional prognosis of mild ischemic stroke(P<0.05).Conclusion The age,diabetes mellitus,major atherosclerotic stroke,stroke history,NIHSS score at admission,intracranial large vessel stenosis or occlusion,acute neurological deterioration,pneumonia,hypertension,cardiogenic cerebral embolism were the influential factors for functional prognosis of mild ischemic stroke.Early identification and targeted intervention measures should be taken to improve the clinical prognosis of mild ischemic stroke patients with the above influencing factors.