降钙素原与急性脑梗死后恶性脑水肿发生的相关性研究

Association between procalcitonin level and the occurrence of malignant brain edemaafter acute cerebral infarction

目的 探讨脑梗死后降钙素原(procalcitonin, PCT)与恶性脑水肿(malignant brain edema, MBE)发展的关系。方法 回顾性收集2017年1月1日—2018年12月31日四川大学华西医院神经内科住院的脑梗死患者资料。根据是否发生MBE分为MBE组和非MBE组。比较分析两组患者的基本信息和神经影像学数据。结果 共纳入患者798例。其中,MBE 93例(11.65%),非MBE 705例(88.35%)。MBE发生时间的中位数(下四分位数,上四分位数)为发病后29(24,54)h。两组患者的入院时美国国立卫生研究院卒中量表评分、大面积大脑中动脉梗死、构音障碍、低热、意识状况、慢性心功能不全、TOAST分型、机械通气、胃管安置、入院第1天PCT、入院第3天PCT比较,差异均有统计学意义(P<0.05);其余指标两组比较,差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,第1天PCT、大面积大脑中动脉梗死均与MBE相关。结论 发病后24 h内PCT升高与急性脑梗死后MBE的发生相关。脑梗死后PCT升高的患者可能需要仔细的临床管理。

Objective To explore the association between procalcitonin(PCT)level and the development of malignant brain edema(MBE)after acute cerebral infarction.Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital,Sichuan University between January 1,2017 and December 31,2018 were retrospective collected.Patients were divided into MBE group and non-MBE group based on whether MBE had occurred.The basic information and neuroimaging data of two groups of patients were compared and analyzed.Results A total of 798 patients were included.Among them,there were 93 cases of MBE(11.65%)and 705 cases of non-MBE(88.35%).The median time of MBE occurrence(lower quartile,upper quartile)was 29(24,54)hours after onset.The difference in the National Institutes of Health Stroke Scale,large-scale middle cerebral artery infarction,dysarthria,low fever,consciousness status,chronic heart failure,TOAST typing,mechanical ventilation,gastric tube placement,PCT on the first and third day of admission between the two groups were statistically significant(P<0.05).There was no statistically significant difference in the other indicators between the two groups(P>0.05).The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE.Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction.Patients with elevated PCT after cerebral infarction may require careful clinical management.