合并新型冠状病毒感染的急性脑梗死患者临床特征和预后

Clinical Characteristics and Prognosis of Acute Ischemic Stroke with COVID-19 Infection

目的:研究新型冠状病毒感染对急性脑梗死患者临床特征和预后的影响。方法:选取2022年12月-2023年2月于常州市妇幼保健院神经内科住院治疗的急性脑梗死患者22例,根据入院时新型冠状病毒感染情况分为未感染组(n=9)与感染组(n=13),比较两组基本临床资料、实验室结果和脑梗死临床特点,3个月后通过电话或门诊随访评估预后情况。结果:感染组的纤维蛋白原低于未感染组,谷草转氨酶高于未感染组,差异均有统计学意义(P<0.05)。两组美国国立卫生研究院卒中量表(NIHSS)评分、住院天数、改良Rankin量表(mRS)评分比较,差异无统计学意义(P>0.05)。随访过程中,感染组1例突发急性心肌梗死死亡,1例出现下肢静脉血栓再次入院,未感染组无复合心脑血管事件发生。mRS评分与吸烟(r=-0.449,P=0.036)、饮酒(r=-0.488,P=0.021)、住院天数(r=0.457,P=0.033)、血浆凝血酶原时间(r=-0.446,P=0.037)、活化部分凝血活酶时间(r=-0.463,P=0.030)具有相关性,与是否合并新型冠状病毒感染无明显相关性。结论:合并新型冠状病毒感染的急性脑梗死患者容易出现肝功能和凝血指标异常,新型冠状病毒感染与急性脑梗死患者神经功能恢复没有明显相关性,但需注意复合心脑血管事件的发生。

Objective To explore the influence of COVID-19 on the clinical characteristics and prognosis of acute ischemic stroke.Methods A total of 22 patients with acute ischemic stroke who were hospitalized in the Neurology Department of Changzhou Maternity and Child Health Care Hospital from December 2022 to February 2023 were selected.They were categorized into the non-infected group(n=9)and the infected group(n=13)based on their COVID-19 infection status upon admission.The basic clinical data,results of laboratory tests and clinical characteristics of acute ischemic stroke were compared.The prognosis of acute ischemic stroke patients was evaluated by telephone or outpatient follow-up three months later.Results Compared with patients in the non-infected group,patients in the infected group had a decrease in fibrinogen(P=0.035)and an increase in aspartate aminotransferase(P=0.042).There was no statistically significant difference in National Institute of Health stroke scale(NIHSS)scores,hospitalization days and modified Rankin scale(mRS)scores between the two groups(P>0.05).During the follow-up process,one patient in the infection group died of acute myocardial infarction and another was readmitted to hospital because of lower limb venous thrombosis.There was no compound cardiovascular event happened in the non-infected group.The correlations between the mRS score and smoking(r=-0.449,P=0.036),alcohol-consumption(r=-0.488,P=0.021),hospitalization days(r=0.457,P=0.033),prothrombin time(r=-0.446,P=0.037),activated partial thromboplastin time(r=-0.463,P=0.030)were statistically significant while the correlation between the mRS score and the infection status of COVID-19 was not statistically significant.Conclusions Acute ischemic stroke patients with COVID-19 were prone to have abnormal indicators of liver function and coagulation.COVID-19 had no significant correlation with the functional recovery of acute ischemic stroke patients but attention should be paid to the occurrence of compound cardiovascular events.