肥胖对首发急性缺血性脑卒中患者静脉溶栓预后不良的影响

Impact of obesity on poor prognosis of intravenous thrombolysis in patients with first-episode acute ischemic stroke

目的探讨肥胖对首发急性缺血性脑卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓预后不良的影响。方法选取2017年12月—2023年12月于苏州大学附属苏州九院神经内科经rt-PA静脉溶栓治疗的297例首发脑梗死患者为研究对象,依据90 d改良的Rankin量表(mRS)评分分为预后不良组(mRS评分为3~6分)和预后良好组(mRS评分为0~2分)。采用多因素Logistic回归分析影响急性缺血性脑卒中静脉溶栓患者90 d预后不良的危险因素。结果297例首发急性缺血性脑卒中患者中,预后良好212例,预后不良85例,预后不良发生率为28.62%。预后不良组肥胖(体重指数≥28.0 kg/m~2)患者占27.06%(23/85)、吸烟患者占31.76%(27/85)、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分为13.00(9.50,18.00)分,高于预后良好组的16.98%(36/212)、20.28%(43/212)及7.00(5.00,11.00)分,差异均有统计学意义(χ^(2)/Z=3.871、4.440、-8.013;P<0.05)。多因素Logistic回归分析显示,肥胖(OR=2.918,95%CI=1.364~6.242)、吸烟(OR=3.648,95%CI=1.678~7.931)、溶栓前NIHSS评分高(OR=1.269,95%CI=1.184~1.361)是急性缺血性脑卒中患者静脉溶栓预后不良的危险因素(P<0.05)。结论肥胖是首发缺血性脑卒中患者静脉溶栓90 d预后不良的危险因素。

Objective To explore the impact of obesity on poor prognosis of recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis in patients with first-episode acute ischemic stroke.Methods From December 2017 to December 2023,297 patients with first-episode stroke who underwent rtPA intravenous thrombolysis in the Department of Neurology of Suzhou Ninth Hospital affiliated to Soochow University were selected as participants.According to the 90 days Modified Rankin Scale(mRS)score,patients were divided into a poor prognosis group(mRS score of 3 to 6)and a good prognosis group(mRS score of 0 to 2).Multivariate Logistic regression was used to analyze the risk factors for poor 90-day prognosis in patients with acute ischemic stroke undergoing intravenous thrombolysis.Results Among 297 patients with firstepisode acute ischemic stroke,212 had good prognosis and 85 had poor prognosis,with a poor prognosis rate of 28.62%.In the poor prognosis group,obese patients(BMI≥28.0 kg/m2)accounted for 27.06%(23/85),smoking patients accounted for 31.76%(27/85),and the National Institute of Health Stroke Scale(NIHSS)score before thrombolysis was 13.00(9.50,18.00),which were higher than the good prognosis group's 16.98%(36/212),20.28%(43/212),and 7.00(5.00,11.00),respectively,and the differences were statistically significant(χ^(2)/Z=3.871,4.440,-8.013;P<0.05).Multivariate Logistic regression analysis showed that obesity(OR=2.918,95%CI=1.364-6.242),smoking(OR=3.648,95%CI=1.678-7.931),and high prethrombolysis NIHSS score(OR=1.269,95%CI=1.184-1.361)were risk factors for poor prognosis in patients with acute ischemic stroke undergoing intravenous thrombolysis,with statistically significant differences(P<0.05).Conclusions Obesity is a risk factor for poor prognosis after 90 days of intravenous thrombolysis in patients with first-episode ischemic stroke.