超敏C反应蛋白和随机血糖与青年卒中患者预后的关系研究  

Association of Hypersensitivity C-reactive Protein and Random Blood Glucose with Prognosis in Young Patients with Stroke

作　　者：贾娇坤[1] 刘艳芳[1] 郭加欢 赵性泉[1] JIA Jiaokun;LIU Yanfang;GUO Jiahuan;ZHAO Xingquan(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京市100070

出　　处：《中国全科医学》2022年第29期3627-3634,共8页Chinese General Practice

基　　金：北京市科学技术委员会资助项目(Z201100005620010)——基于人工智能的脑血管病临床诊疗决策研究;北京市医院管理中心创新梦工场(202112)。

摘　　要：背景青年卒中可导致长期残疾,造成沉重的社会、家庭负担。研究认为超敏C反应蛋白(hs-CRP)和应激性血糖升高可增加缺血性卒中发生及其预后不良等风险,但截至目前,尚缺乏青年卒中人群的研究证据。目的分别探讨hs-CRP和随机血糖与青年卒中患者神经功能缺损及长、短期预后的关系。方法回顾性选取2019—2021年首都医科大学附属北京天坛医院神经病学中心收治的发病72 h内到院的18~45岁首次缺血性卒中患者。收集患者的人口学信息、危险因素、实验室结果、并发症等。根据hs-CRP四分位数将患者分为4组,即Q1组(n=160)、Q2组(n=156)、Q3组(n=157)、Q4组(n=157);又根据随机血糖四分位数将患者分为4组,即q1组(n=158)、q2组(n=158)、q3组(n=157)、q4组(n=157)。以出院时美国国立卫生研究院卒中量表(NIHSS)评分>4分作为神经功能缺损标准,出院时改良Rankin量表(mRS)评分2~5分作为短期预后不良标准,90 d mRS评分2~5分作为长期预后不良标准。采用多因素Logistic回归分析探讨hs-CRP、随机血糖与神经功能缺损、短期预后不良、长期预后不良的关系。结果630例患者中神经功能缺损154例(24.4%),短期预后不良217例(34.4%),长期预后不良144例(22.9%)。Logistic回归分析结果显示,与Q1组相比,Q3组和Q4组神经功能缺损〔OR=2.86,95%CI(1.56,5.22);OR=2.99,95%CI(1.63,5.50)〕、短期预后不良〔OR=2.14,95%CI(1.25,3.66);OR=2.80,95%CI(1.62,4.83)〕、长期预后不良〔OR=3.17,95%CI(1.67,6.01);OR=3.61,95%CI(1.90,6.86)〕的发生风险均增加(P<0.01)。Logistic回归分析结果显示,与q1组相比,q3组长期预后不良的发生风险增加〔OR=1.94,95%CI(1.07,3.53)〕,q4组短期预后不良〔OR=2.05,95%CI(1.11,3.82)〕、长期预后不良〔OR=2.62,95%CI(1.31,5.24)〕的发生风险均增加(P<0.05)。且在进一步排除肺部感染、泌尿系感染及感染性腹泻人群后仍得到一致结果。结论hs-CRP>1.18 mg/L是青年卒中患�Background Stroke in young people can lead to long-term disability and heavy social and family burden.Studies have shown that increased hypersensitivity C-reactive protein(hs-CRP)and stress blood glucose were associated with increased risk of ischemic stroke occurrence and its poor prognosis,but so far,there is still lack of research evidence in young patients with stroke.Objective To explore the association of hs-CRP and random blood glucose with neurological impairment,long-term and short-term prognosis in young patients with stroke,respectively.Methods Patients aged 18 to 45 years with first ever ischemic stroke,admitted within 72 hours of onset to the Department of Neurology,Beijing Tiantan Hospital Affiliated to Capital Medical University from 2019 to 2021 were retrospectively selected.Demographic information,risk factors,laboratory results and complications,etc.of the patients were collected.Patients were divided into 4 groups according to the quartile of hs-CRP:group Q1(n=160),group Q2(n=156),group Q3(n=157),group Q4(n=157);patients were also divided into four groups according to the quartile of random blood glucose:group q1(n=158),group q2(n=158),group q3(n=157),group q4(n=157).The National Institutes of Health Stroke Scale(NIHSS)score>4 was used as the criterion of neurological deficit at discharge,the modified Rankin Scale(mRS)score of 2-5 was used as the criterion of poor short-term prognosis at discharge,and the mRS score of 2 to 5 at 90 d was used as the criterion of poor long-term prognosis.Logistic regression analysis was used to explore the association of hs-CRP and random blood glucose with neurological impairment,poor short-term and long-term prognosis.Results Among 630 patients,154(24.4%)patients suffered neurological impairment,217(34.4%)patients had poor short-term prognosis,and 144(22.9%)patients had poor long-term prognosis.Multiple Logistic regression analysis showed that compared with group Q1,the risks of neurological impairment〔OR=2.86,95%CI(1.56,5.22);OR=2.99,95%CI(1.63,5.50)〕,poor

关 键 词：卒中 青年人 超敏C反应蛋白 随机血糖 神经功能缺损 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]