急性脑梗死静脉溶栓短期预后的影响因素分析  

Influencing factors of short-term prognosis of intravenous thrombolysis in acute cerebral infarction

作　　者：孙培丽[1] 孙贵祥[1] 许秀兰[1] Sun Peilin;Sun Guixiang;Xu Xiulan(Department of Neurology,Rugao People's Hospital,Nantong 226500,China)

机构地区：[1]如皋市人民医院神经内科,江苏南通226500

出　　处：《北京医学》2022年第3期209-212,共4页Beijing Medical Journal

摘　　要：目的探讨急性脑梗死(acute cerebral infarction,ACI)静脉溶栓短期预后的影响因素。方法选取2018年6月至2021年4月如皋市人民医院收治的83例ACI患者,收集患者临床资料,于患者入院24 h内检测外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)和B型利尿钠肽(B-type natriuretic peptide,BNP)水平。于治疗2周后复查头颅CT/MRI,并结合格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分将其分为预后良好组和预后不佳组。以多因素logistic回归分析探讨影响ACI静脉溶栓后短期预后不佳的影响因素。结果83例ACI患者中,预后不佳组45例,预后良好组38例。预后不佳组糖尿病史(17.8%比2.6%)、入院24 h的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≥15分占比(46.7%比23.7%)及血清BNP[(264.31±76.04)pg/ml比(91.34±15.21)pg/ml]、同型半胱氨酸(homocysteine,Hcy)[(18.12±3.51)μmol/L比(14.73±3.29)μmol/L]和NLR[(2.16±0.24)比(1.69±0.35)]水平均高于预后良好组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,糖尿病史(OR=3.040,95%CI:1.176~7.861,P=0.002)、入院24 h NIHSS评分≥15分(OR=3.684,95%CI:1.425~9.524,P=0.001)及血清BNP(OR=2.835,95%CI:1.096~7.329,P=0.001)和NLR(OR=3.842,95%CI:1.486~9.933,P=0.001)水平偏高为ACI静脉溶栓后短期内预后不佳的危险因素。结论存在糖尿病史、入院24 h NIHSS评分≥15分、血清BNP及NLR水平偏高的ACI静脉溶栓患者更易出现预后不佳的情况。Objective To investigate the influencing factors of short-term prognosis of intravenous thrombolysis in acute cerebral infarction(ACI).Methods A total of 83 ACI patients admitted to Rugao People’s Hospital from June 2018 to April 2021 were selected.The clinical data were collected,and the levels of neutrophil to lymphocyte ratio(NLR)and B-type natriuretic peptide(BNP)in peripheral blood were measured within 24 hours of admission.After two weeks of treatment,the head CT/MRI was reviewed.And combined with the Glasgow coma scale(GCS),they were divided into good prognosis group and poor prognosis group.Multivariate logistic regression analysis was used to investigate the influencing factors of poor short-term prognosis after intravenous thrombolysis in ACI.Results Among 83 patients with ACI,45 cases were in the poor prognosis group and 38 cases were in the good prognosis group.The history of diabetes(17.8%vs.2.6%),proportion of National Institutes of Health Stroke Scale(NIHSS)score≥15 points at 24 h after admission[(46.7%vs.23.7%)]and serum BNP[(264.31±76.04)pg/ml vs.(91.34±15.21)pg/ml],homocysteine(Hcy)[(18.12±3.51)μmol/L vs.(14.73±3.29)μmol/L]and the level of NLR[(2.16±0.24)vs.(1.69±0.35)]in the poor prognosis group were higher than those in the good prognosis group,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that history of diabetes(OR=3.040,95%CI:1.176-7.861,P=0.002),NIHSS score≥15 points within 24 h after admission(OR=3.684,95%CI:1.425-9.524,P=0.001),serum BNP(OR=2.835,95%CI:1.096-7.329,P=0.001)and NLR(OR=3.842,95%CI:1.486-9.933,P=0.001)were risk factors for poor prognosis in the short term after intravenous thrombolysis of ACI.Conclusions ACI intravenous thrombolysis patients with history of diabetes,24-hour NIHSS score≥15 points,and high levels of serum BNP and NLR are more likely to have a poor prognosis.

关 键 词：急性脑梗死 静脉溶栓 中性粒细胞与淋巴细胞比值 B型利尿钠肽 短期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]