急性缺血性卒中合并肌钙蛋白I升高的相关因素和预后研究  

Troponin I elevation in acute ischemic stroke: risk factors exploration and outcome evaluation

作　　者：钟伙花 屈剑锋[2] 肖卫民[2] 陈仰昆[2] 丘东海[2] 罗根培[2] ZHONG Huohua;QU Jianfeng;XIA0 Weimin;CHEN Yangkun;QIU Donghai;LUO Genpei(Faculty of Neurology,Guangdong Medical University,Zhanjiang 524000,China;Department of Neurology,Dongguan People's Hospital,Dongguan 523000,China)

机构地区：[1]广东医科大学研究生院,广东湛江524000 [2]东莞市人民医院神经内科,广东东莞523000

出　　处：《内科理论与实践》2019年第5期289-293,共5页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨急性缺血性卒中患者合并心肌肌钙蛋白I(cardiac troponin I,cTnI)升高的临床和影像学相关因素,以及其对预后的影响。方法:回顾性分析166例心肌缺血性卒中患者的临床资料、影像学资料,以及卒中后3个月时的功能状态,分析cTnI升高的危险因素及cTnI对功能性预后的影响。结果 :在166例患者中,起病年龄为19岁,平均(64.71±13.47)岁,男性107例(64.5%),女性59例(35.5%)。26例(15.7%)患者cTnI升高。单因素分析显示,cTnI升高组较cTnI正常组年龄大[(70.5±14.3)岁比(63.6±13.1)岁, P=0.016],合并糖尿病(46.2%比24.3%, P=0.022)、心房颤动(19.2%比9.3%, P=0.022)比例高,神经系统功能缺损更严重[入院时的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分4(2,12.3)分比3(1,6)分, P=0.042], ST-T改变(38.9%比14.7%, P=0.013)、异常Q波(22.2%比6.4%, P=0.027)更多。二元Logistic回归分析显示,糖尿病、心房颤动、异常Q波是急性缺血性卒中患者出现cTnI升高的危险因素。在纠正混杂因素后发现,cTnI水平升高不是影响预后的危险因素。结论:在急性缺血性脑卒中患者中,cTnI升高者合并有糖尿病、心房颤动、异常Q波比例更高,但cTnI升高并非影响预后的危险因素。Objective To explore risk factors involved in troponin I(cTnI) elevation during acute phase of ischemic stroke, and evaluate the implication of increased cTnI in clinical outcome of stroke. Methods The clinical and imaging data of 166 patients with ischemic stroke had been retrospectively analyzed, and their outcomes at 3 months were followed.Results Among all the patients investigated, including 107 males(64.5%) and 59 females(35.5%) with an average age of(64.71±13.47) years, twenty-six(15.7%) had elevated cTnI. The univariance analysis revealed the elevated cTnI might be attributed to older age [(70.5±14.3) years vs(63.6±13.1) years, P=0.016], presence of diabetes mellitus(46.2% vs 24.3%,P=0.022), and higher National Institutes of Health Stroke Scale(NIHSS) score on admission [4(2, 12.3) vs 3(1, 6), P=0.042]. The elevated c TnI was also associated with atrial fibrillation(9.3% vs 19.2%, P=0.02), ST-T change(14.7% vs38.9%, P=0.013) and abnormal Q wave(6.4% vs 22.2%, P=0.027). The history of diabetes mellitus, atrial fibrillation and abnormal Q wave on electrocardiogram were established as independent risk factors for elevated cTnI in patients with acute ischemic stroke by Logistic regression analysis. Analysis with adjusted the confounders showed that elevated cTnI did not a constitute a poor prognosis factor at 3 months post incidence of ischemic stroke. Conclusions The elevated cTnI might associate with a history of diabetes mellitus, atrial fibrillation and abnormal Q waves on electrocardiogram. And elevation of cTnI does not bode poor come at 3 months post ischemic stroke.

关 键 词：急性缺血性脑卒中 肌钙蛋白I 心房颤动 异常Q波 

分 类 号：R743[医药卫生—神经病学与精神病学]