早期核心梗死增长速率预测大血管闭塞性急性缺血性脑卒中患者预后的价值

The value of EIGR in predicting prognosis of patients with acute ischemic stroke with large vessel occlusion

目的探讨早期核心梗死增长速率(early infarct growth rate,EIGR)对急性大血管闭塞性缺血性脑卒中患者临床预后的影响。方法选取2020年1月1日至2022年12月31日于南京医科大学第一附属医院急诊科就诊的急性大血管闭塞性缺血性脑卒中患者164例。根据就诊时和治疗后72 h美国国立卫生研究院卒中量表(NIHSS)评分改变值分为预后良好组和预后不佳组,观察并比较两组患者基本临床资料,采用单因素回归分析预后不佳的危险因素。并深入分析年龄分层后核心梗死增长速率对预后的影响。结果对比两组临床资料发现,两组核心梗死增长速率(mL/h)(7.67 vs.8.24,P=0.211)差异无统计学意义。纳入核心梗死增长速率和年龄之间的乘积作为交互项,模型中交互项的结果有统计学意义(OR=1.002,95%CI:1.000~1.003,P=0.032),并且在校正了相关变量后(性别、高血压史、房颤史、糖尿病史、冠心病史、脑卒中史)结果仍有统计学意义(OR=1.002,95%CI:1.000~1.003,P=0.027)。对年龄按照中位数(71岁)进行亚组分析,高龄组中,依据25 mL/h和15 mL/h界定的快速型核心梗死增长速率的不良预后占比更高(P<0.05),低龄组中,快速型核心梗死增长速率的不良预后比例较缓慢型差异无统计学意义(P>0.05)。结论核心梗死增长速率在老年大血管闭塞性缺血性脑卒中患者中可早期预测临床预后。

Objective To investigate the effect of Early infarct growth rate(EIGR)on the prognosis of patients with acute large vessel occlusive ischemic stroke.Methods A total of 164 patients with acute large vessel occlusive ischemic stroke were enrolled in the emergency department of the First Affi liated Hospital of Nanjing Medical University from January 1,2020 to December 31,2022.According to the change of the National Institutes of Health Stroke Scale(NIHSS)score at admission and 72 h after treatment,the patients were divided into good prognosis group and poor prognosis group.The basic clinical data of the two groups were observed and compared.The risk factors of poor prognosis were analyzed by univariate regression.The effect of EIGR on prognosis after age stratification was further analyzed.Results Comparing the clinical data of the two groups,there was no difference in EIGR(mL/h)(7.67 vs.8.24,P=0.211)between the two groups.The product between EIGR and age was included as the interaction term,and the result of the interaction term in the model was statistically signifi cant(OR=1.002,95%CI:1.000-1.003,P=0.032).Moreover,the result was still statistically signifi cant after adjusting for relevant variables(gender,history of hypertension,history of atrial fi brillation,history of diabetes,history of coronary heart disease,and history of stroke)(OR=1.002,95%CI:1.000-1.003,P=0.027).Subgroup analysis was performed according to the median age(71 years).In the elderly group,the proportion of poor prognosis was higher with fast core infarction growth rate defi ned by 25 mL/h and 15 mL/h(P<0.05).In the younger age group,there was no signifi cant difference in the proportion of poor prognosis in the fast core infarction growth rate compared with the slow type(P>0.05).Conclusions EIGR can predict the early clinical outcome early in elderly patients with large vessel occlusive ischemic stroke.