内囊预警综合征患者进展为急性脑梗死的危险因素分析  

Risk factor analysis for the progression from capsular warning syndrome to acute cerebral infarction

作　　者：田广平[1] 邹宁[1] 马颖 孙鹏 TIAN Guangping;ZOU Ning;MA Ying;SUN Peng(Department of Neurology,the Second Hospital of Qinhuangdao,Qinhuangdao 066600,Hebei,China;Department of Neurology,Tangshan Workers'Hospital,Tangshan 063003,Hebei,China)

机构地区：[1]秦皇岛市第二医院神经内科,河北秦皇岛066600 [2]唐山工人医院神经内科,河北唐山063003

出　　处：《贵州医科大学学报》2022年第8期947-952,共6页Journal of Guizhou Medical University

基　　金：秦皇岛市市级科技计划重点研发计划(201703A127);河北省重点研发计划项目(182777125D)。

摘　　要：目的 分析内囊预警综合征(CWS)患者进展为急性脑梗死的危险因素。方法 100例CWS患者根据颅脑扩散加权成像是否存在新发急性脑梗死病灶分为合并急性脑梗死组(n=58)和单纯CWS组(n=42),收集两组患者一般资料[性别、年龄、高血压、高血脂、高同型半胱氨酸血症、糖尿病、吸烟史、饮酒史、动脉粥样硬化、脑白质脱髓鞘的发生情况,感觉和(或)运动障碍发作次数及持续时间、收缩压(SBP)及舒张压(DBP)],取外周静脉血检测血清胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平;对两组患者有差异指标采用多因素logistic回归分析,根据CWS患者进展为急性脑梗死的危险因素建立风险预测模型;采用概率logit(p)绘制预测CWS进展为急性脑梗死的受试者工作特征(ROC)曲线,采用曲线下面积(AUC)评估风险预测模型对CWS患者进展为急性脑梗死预测价值。结果 CWS患者进展为急性脑梗死发生率为58.00%,合并急性脑梗死组患者的年龄、FPG水平、感觉和(或)运动障碍发作次数、脑白质脱髓鞘比例高于单纯CWS组(P<0.05);logistic多元回归分析显示,年龄升高、FPG水平较高、多次发作、合并脑白质脱髓鞘均为CWS进展为急性脑梗死的危险因素(OR=2.375、1.872、2.132、2.042,P<0.05);建立风险预测模型为logistic(P)=-12.343+年龄×0.312+FPG×1.160+发作次数×1.200+合并脑白质脱髓鞘×1.179, ROC曲线结果显示logit(p)> 11.01时,模型预测CWS进展为急性脑梗死的AUC为0.859,敏感度为89.66%,特异度为76.19%。结论 CWS患者进展为急性脑梗死率较高,年龄升高、FPG水平升高、发作次数增加、合并脑白质脱髓鞘等因素是CWS患者进展为急性脑梗死的危险因素,本研究建立的风险预测模型对CWS患者进展为急性脑梗死具有一定的预测价值。Objective To analyze risk factors of the progression of capsular warning syndrome(CWS) to acute cerebral infarction.Methods A total of 100 inpatients with CWS were divided into combined acute cerebral infarction(n=58) and non-acute cerebral infarction groups(n=42)according to the presence or absence of new acute cerebral infarction lesions on brain diffusionweighted imaging.The general data of two groups were collected, including gender, age,hypertension, hyperlipidemia, hyperhomocysteinemia, diabetes mellitus, smoking history, drinking history, atherosclerosis, the occurrence of white matter demyelination, the numbers and duration of sensory and/or onset of movement disorders, systolic blood pressure( SBP), and diastolic blood pressure(DBP).Peripheral venous blood was withdrawn to detect serum cystatin C(CysC), highsensitivity C-reactive protein(hs-CRP), uric acid(UA), triglyceride(TG), total cholesterol(TC),fasting plasma glucose( FPG), high density Lipoprotein cholesterol( HDL-C), and low density lipoprotein cholesterol( LDL-C).Multivariate logistic regression analysis was run on the indicators with differences between two groups.A risk prediction model was established according to the risk factors of the patients with CWS progressing to acute cerebral infarction.Probability logit(P) was used to visualize the receiver operating characteristics(ROC) curves for predicting the progression of CWS to acute cerebral infarction.Area under ROC curve(AUC) was calculated to assess the predictive value of the risk prediction model for the progression of CWS to acute cerebral infarction.Results The incidence rate of patients with CWS progressing to acute cerebral infarction was 58.00%.The age,FPG level, the number of sensory and/or onset of movement disorders, and white matter demyelination ratio were higher in the combined acute cerebral infarction group than those in non-acute cerebral infarction group(P< 0.05).Multiple logistic regression analysis revealed that increased age, high FPG level, multiple seizures and cereb

关 键 词：内囊预警综合征 急性脑梗死 颅脑扩散加权成像 血液指标 危险因素 风险预测模型 受试者工作特征曲线 

分 类 号：R743.3[医药卫生—神经病学与精神病学]