急性脑梗死患者溶栓治疗后早期神经功能恶化及再梗死危险因素分析

Analysis of risk factors for early neurological deterioration and reinfarction in patients with acute cerebral infarction after thrombolytic therapy

目的 探讨接受rt-PA静脉溶栓治疗的急性脑梗死(ACI)患者发生早期神经功能恶化及再梗死的相关影响因素。方法 收集2021年1月~2022年12月于潍坊市益都中心医院急诊神经科诊断为ACI并接受rt-PA静脉溶栓患者的临床资料,静脉溶栓治疗后24h时NIHSS评分较基线水平增加≥4分为早期神经功能恶化(END)组,其余为非END组。收集入组时采集一般信息、实验室和影像学相关指标数据,采用单因素分析和多因素Logistic回归分析评估ACI患者经rt-PA静脉溶栓后发生END的危险因素。绘制ROC曲线,评价各个危险因素对END的诊断价值。对END组进行为期3个月的随访,根据随访期间是否发生再梗死将患者分成未再梗死组和再梗死组。采用Logistic回归分析END组患者发生再梗死的影响因素。结果 (1)266例ACI患者62例(23.31%)发生END。相较于非END组患者,END组患者入院时的NIHSS评分、舒张压、空腹血糖、总胆固醇、同型半胱氨酸、纤维蛋白原、白细胞计数的水平显著增高(P<0.05)。END组中合并心房颤动、大动脉粥样硬化型ACI患者数量显著高于非END组(P<0.05)。ROC分析显示基线NIHSS评分、收缩压、空腹血糖、同型半胱氨酸、纤维蛋白原等指标均对END的发生有诊断意义。(2)END发生后的3个月内,END组中11例(17.74%)患者发生再梗死,再梗死组吸烟史、合并高血压和心房颤动的例数以及基线NIHSS评分、总胆固醇、同型半胱氨酸、纤维蛋白原、D-二聚体的水平均高于未再梗死组(P<0.05),高密度脂蛋白胆固醇的水平低于未再梗死组(P<0.05)。结论 基线NIHSS评分、收缩压、空腹血糖、同型半胱氨酸、纤维蛋白原水平是发生END的独立危险因素,对END的发生具有临床诊断意义,亦是END患者发生再梗死的独立危险因素。

Objective To explore the related factors of early neurological deterioration and reinfarction in patients with acute cer-ebral infarction(ACI)who receive rt-PA intravenous thrombolysis treatment.Methods Clinical data of patients diagnosed with ACI in the E-mergency Neurology Department of Yidu Central Hospital in Wei fang City from January 2021 to December 2022 who received rt PA intrave-nous thrombolysis were collected.After 24 hours of intravenous thrombolysis treatment,patients with an increase of≥4 points in NIHSS score compared to baseline were classified as early neurological deterioration(END)group,while the rest were classified as non END group.Collect general information,laboratory and imaging related indicator data collected during enrollment,and use univariate analysis and multivariate Lo-gistic regression analysis to evaluate the risk factors for END in ACI patients after rt PA intravenous thrombolysis.Draw ROC curves to evaluate the diagnostic value of various risk factors for END.Follow up the END group for a period of three months,and divide the patients into non reinfarction group and reinfarction group based on whether reinfarction occurred during the follow-up period.Use Logistic regression to analyze the influencing factors of recurrent infarction in END group patients.Results END occurred in 62(23.31%)of 266 ACI patients.Compared with the non-end group,the levels of National Institutes of Health Stroke Scale(NIHSS)score,diastolic blood pressure,fasting blood glucose,total cholesterol,homocysteine,fibrinogen,and white blood cell count in the END group were significantly increased(P<0.05).In addition,the number of patients with atrial fibrillation and large atherosclerotic ACI in END group was significantly higher than that in non-END group(P<0.05).Elevated baseline NIHSS score,systolic blood pressure,fasting blood glucose,homocysteine,and fibrinogen levels were independent risk factors for END.In addition,baseline NIHSS score,systolic blood pressure,fasting blood glucose,homocysteine and fibrinogen showed certain clinical diagnostic accuracy for the occurrence of END.②Within three months after the occurrence of END,1l patients(17.74%)in the END group had re-infarction.The smoking history,the number of cases with hypertension and atrial fibrllation,the baseline NIHSS score,total cholesterol,homocysteine,fibrinogen,and D-dimer levels in the reinfarction group were higher than those in the non-reinfarction group(P<0.05),while the high-density lipoprotein cholesterol(HDL-C)levels were lower than those in the non-reinfarction group(P<0.05).Conclusion Baseline NIHSS score,systolic blood pressure,fasting blood glucose,homocysteine,and fibrinogen levels are independent risk factors for the occurrence of END,which has a certain clinical diagnostic accuracy and is also an independent risk factor for recurrent infarction in END patients.The incidence of END in ACI patients after rt-PA treatment is 23.31%.