急性缺血性卒中患者早期神经功能恶化的预测因素  

Predictors of early neurological deterioration in patients with acute ischemic stroke

作　　者：孙美 侯晓夏 吕梦伟 张杨杨[3] 程虹[1] Sun Mei;Hou Xiaoxia;Lyu Mengwei;Zhang Yangyang;Cheng Hong(Department of Neurology,the Firt Affilicaed Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Neurology,Suzhou Municogal Hospital,Suzhou 215000,China;Department of Cardiac Surgery,Dongfang Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]南京医科大学第一附属医院神经内科,210029 [2]苏州市立医院神经内科,215000 [3]同济大学附属东方医院心脏外科,上海200120

出　　处：《国际脑血管病杂志》2018年第9期654-659,共6页International Journal of Cerebrovascular Diseases

基　　金：江苏省“六大人才高峰”项目（WSN-025）

摘　　要：目的 探讨急性缺血性卒中（acute ischemic stroke,AIS）患者发生早期神经功能恶化（early neurological deterioration,END）的预测因素.方法 回顾性收集2015年1月至2018年4月南京医科大学第一附属医院神经内科收治的未接受溶栓治疗和血管内治疗的AIS患者,END定义为发病后7 d内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分较基线增加≥2分.比较END组和非END组患者的基线临床资料、影像学检查及实验室检查结果.采用多变量logistic回归分析确定END的独立预测因素.结果共纳入652例AIS患者,男性437例（67.0％）.END组247例（37.9％）,非END组405例（62.1％）.两组低密度脂蛋白胆固醇、空腹血糖、高半胱氨酸、脂蛋白（a）、中性粒细胞百分比、NIHSS评分差异有统计学意义（P均〈0.05）.两组卒中严重程度、责任血管严重病变、分水岭梗死、卒中病因学分型、牛津郡社区卒中项目分型及发病前服用他汀类药物患者的构成比差异有统计学意义（P均〈0.05）.多变量logistic回归分析显示,脂蛋白（a）[优势比（odds ratio,OR）1.001,95％ 可信区间（confidence interval,CI）1.000～1.002;P=0.021]、完全前循环梗死（OR 3.842,95％CI 1.383～10.671;P=0.003）和部分前循环梗死（OR 2.642,95％CI 1.486～4.695;P=0.001）是END的独立危险因素,而发病前服用他汀类药物是END的独立保护因素（OR 0.222,95％CI 0.072～0.679;P=0.008）.结论 脂蛋白（a）、完全前循环梗死及部分前循环梗死是 END 的独立危险因素,发病前服用他汀类药物是 END 的独立保护因素.Objective To investigate the predictors of early neurological deterioration （END） in patients with acute ischemic stroke （AIS）. Methods From January 2015 to April 2018, patients with AIS without receiving thrombolytic therapy and endovascular treatment admitted to the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University were collected retrospectively. END was defined as National Institutes of Health Stroke Scale （NIHSS） score increased by ≥2 within 7 days after onset from baseline. The baseline clinical data, imaging examinations, and laboratory findings were compared in patients of the END group and the non-END group. Multivariate logistic regression analysis was used to determine the independent predictors of END. Results A total of 652 patients with AIS were enrolled,including 437 males （67. 0％）. There were 247 patients （37. 9％） in the END group and 405 （62. 1％） in the non-END group. There were significant differences in low-density lipoprotein cholesterol, fasting blood glucose, homocysteine, lipoprotein （a）, neutrophil percentage, and NIHSS scores between the 2 groups （all P 〈 0. 05）. There were significant differences in the proportion of severity of stroke, serious lesion of the guilty vessels, watershed infarction, etiologic classification of stroke, Oxfordshire Community Stroke Projects classification, and taking statins before onset between the 2 groups （all P 〈 0. 05 ）. Multivariate logistic regression analysis showed that lipoprotein （a） （odds ratio [OR] 1. 001, 95％ confidence interval [CI] 1. 000-1. 002; P = 0. 021）, total anterior circulation infarcts （OR 3. 842, 95％CI 1. 383-10. 671; P =0. 003）, and partial anterior circulation infarcts （OR 2. 642, 95％CI 1. 486-4. 695; P = 0. 001） were the independent risk factors for END, and prior statin use was an independent protective factor of END （OR 0. 222, 95％CI 0. 072-0. 679; P = 0. 008）. Conclusion Lipoprotein （a）, total anterior circulation in

关 键 词：卒中 脑缺血 疾病恶化 时间因素 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]