首发青年急性脑梗死患者预后相关因素分析  

Analysis of prognostic factors in young patients with first-episode acute cerebral infarction

作　　者：师昱姗 庄飞 SHI Yushan;ZHUANG Fei(Department of Internal Medicine,Fifth People's Hospital of Pingdingshan,Pingdingshan 467000,China)

机构地区：[1]平顶山市第五人民医院内科,河南平顶山467000

出　　处：《社区医学杂志》2023年第7期351-356,共6页Journal Of Community Medicine

摘　　要：目的 分析首发青年急性脑梗死(ACI)患者预后的相关影响因素及其预测预后的效能。方法 以2018-01-01-2021-12-01平顶山市第五人民医院收治的264例首发青年ACI患者为研究对象,根据治疗后6个月Rankin修订量表(mRS)评分将患者分为预后良好组(0~2分,168例)和预后不良组(3~6分,96例)。采用院内自制一般资料问卷收集患者一般资料,调查患者血脂异常情况,测定同型半胱氨酸(Hcy)、D-二聚体(D-D)、C反应蛋白(CRP)和血清前清蛋白(PA)水平,美国国立卫生研究院卒中量表(NIHSS)评分评估患者神经功能损伤程度。多因素logistic回归模型分析影响首发青年ACI预后的危险因素。受试者工作曲线(ROC)分析logistic多因素回归模型对首发青年ACI预后不良的预测价值。结果 首发青年ACI预后不良发生风险为36.36%(96/264)。单因素分析结果显示,预后良好组糖尿病(χ^(2)=5.583,P=0.018)、动脉溶栓手术率(χ^(2)=18.406,P<0.001)、脑梗死体积(t=34.409,P<0.001)、高血压(χ^(2)=76.879,P<0.001)、Hcy水平(t=33.527,P<0.001)、CRP水平(t=26.155,P<0.001)、D-D水平(t=24.782,P<0.001)和白细胞水平(t=15.426,P<0.001)低于预后不良组,PA水平(t=17.028,P<0.001)高于预后不良组,差异有统计学意义。多因素logistic回归分析结果显示,糖尿病(OR=5.511,95%CI为2.748~11.054,P<0.001)、动脉溶栓(OR=5.067,95%CI为1.581~16.238,P<0.001)、脑梗死体积>15.61 cm^(3)(OR=6.639,95%CI为3.659~12.045,P<0.001)、高血压(OR=8.930,95%CI为4.023~19.824,P<0.001)、Hcy水平>13.02μmol/L(OR=6.166,95%CI为2.185~17.403,P<0.001)、CRP水平>5.78 mg/L(OR=5.955,95%CI为2.297~15.436,P<0.001)、D-D水平>0.26 mg/L(OR=7.430,95%CI为3.715~14.861,P<0.001)、PA水平≤199.94 mg/L(OR=0.426,95%CI为0.215~0.846,P<0.001)和白细胞水平>7.26×10^(9 )L^(-1)(OR=9.936,95%CI为5.621~17.563,P<0.001)是首发青年ACI预后不良的危险因素。ROC结果表明,曲线下面积(AUC)为0.922,95%CI为0.883~0.951,灵敏度为76.04%,特异度为92.26%�Objective To analyze the factors related to the prognosis of young patients with first-episode acute cerebral infarction(ACI)and their efficacy in predicting the prognosis.Methods Taking 264 young patients with first-episode ACI admitted to Pingdingshan Fifth People's Hospital from January 1,2018 to December 1,2021 as the study object,the patients were divided into two groups according to modified Rankin scale(mRS)score 6 months after treatment:good prognosis group(0-2 points,168 cases)and poor prognosis group(3-6 points,96 cases).The general data of patients were collected by the self-made general data questionnaire in the hospital,and the abnormal condition of blood lipids was investigated.The levels of homocysteine(Hcy),D-Dimer(D-D),C-reactive protein(CRP)and serum prealbumin(PA)were measured.The degree of neurological impairment was evaluated by the score of the National Institutes of Health Stroke Scale(NIHSS).Multivariate logistic regression model was used to analyze the risk factors affecting the prognosis of first-episode young people with ACI.Receiver operating characteristic(ROC)was used curve analysis of the predictive value of logistic multivariate regression model for poor prognosis in first-episode youth with ACI.Results The risk of poor prognosis in the first-episode young ACI was 36.36%(96/264).Univariate analysis showed that,the levels of diabetes(χ^(2)=5.583,P=0.018),operation rate of arterial thrombolysis(χ^(2)=18.406,P<0.001),cerebral infarction volume(t=34.409,P<0.001),hypertension(χ^(2)=76.879,P<0.001),Hcy(t=33.527,P<0.001),CRP(t=26.155,P<0.001),D-D(t=24.782,P<0.001),and white blood cells(t=15.426,P<0.001)in good prognosis group were lower than those in the poor prognosis group,and the PA level was higher than that in the poor prognosis group(t=17.028,P<0.001).The results of multivariate logistic regression analysis showed that,diabetes(OR=5.511,95%CI:2.748-11.054,P<0.001),arterial thrombolysis(OR=5.067,95%CI:1.581-16.238,P<0.001),cerebral infarction volume15.61cm^(3)(OR=6.639,95%CI:3.659

关 键 词：青年 急性脑梗死 同型半胱氨酸 D-二聚体 C反应蛋白 血清前清蛋白 

分 类 号：R743.33[医药卫生—神经病学与精神病学]