急性脑梗死静脉溶栓患者90 d预后危险因素分析  

Analysis of Risk Factors of 90 d Prognosis in Patients with Acute Cerebral Infarction after Intravenous Thrombolysis Therapy

作　　者：陈凤 柏晓林 张力壬 王枫[1] 徐敏[2] 项静燕[1] 耿直[1] CHEN Feng;BAI Xiaolin;ZHANG Liren;WANG Feng;XU Min;XIANG Jingyan;GENG Zhi(Department of Neurology,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Emergency,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院神经内科,上海200233 [2]上海交通大学医学院附属第六人民医院急诊科,上海200233

出　　处：《医学综述》2023年第3期590-595,共6页Medical Recapitulate

基　　金：上海市科学技术委员会科研计划项目(19401972805)。

摘　　要：目的分析影响急性脑梗死静脉溶栓患者90 d预后的危险因素。方法回顾性分析2019年1月至2022年3月上海交通大学医学院附属第六人民医院收治的187例使用重组组织型纤溶酶原激活剂静脉溶栓治疗的急性脑梗死患者的基本临床资料、实验室检查、影像学检查以及卒中后90 d的改良Rankin量表(mRS)评分,根据90 d mRS评分将患者分为预后良好组(mRS评分0~2分),预后不良组(mRS评分3~6分),采用单因素分析以及二元Logistic逐步回归分析法分析影响急性脑梗死静脉溶栓患者90 d预后的危险因素。结果发病后90 d,187例患者中预后良好112例,预后不良75例。预后不良组患者年龄>72岁、基线美国国立卫生研究院卒中量表(NIHSS)评分>6分、中性粒细胞与淋巴细胞比值>2.55、高敏心肌肌钙蛋白I(hs-cTnI)>0.006μg/L、肌酸激酶同工酶>1.70μg/L、空腹血糖>5.81 mmol/L以及女性、高血压、冠心病、心房颤动、既往卒中史患者占比均高于预后良好组[61.3%(46/75)比37.5%(42/112)、61.3%(46/75)比29.5%(33/112)、58.7%(44/75)比43.8%(49/112)、62.7%(47/75)比38.4%(43/112)、58.7%(44/75)比43.8%(49/112)、61.3%(46/75)比42.0%(47/112)、33.3%(25/75)比17.0%(19/112)、84.0%(63/75)比66.1%(74/112)、21.3%(16/75)比8.0%(9/112)、34.7%(26/75)比14.3%(16/112)、24.0%(18/75)比12.5%(14/112)](P<0.05或P<0.01)。两组是否有糖尿病、吸烟史及不同入院到溶栓时间、收缩压、舒张压、国际标准化比值、血小板计数、肌酐、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血钙比例比较差异均无统计学意义(P>0.05)。二元Logistic逐步回归分析结果显示,心房颤动(OR=2.349,95%CI 1.022~5.401)、既往卒中史(OR=3.196,95%CI 1.283~7.960)、空腹血糖>5.81 mmol/L(OR=2.400,95%CI 1.199~4.807)、hs-cTnI>0.006 g/L(OR=2.064,95%CI 1.041~4.090)以及基线NIHSS评分>6分(OR=3.779,95%CI 1.898~7.521)是脑梗死溶栓患者90 d预后的危险因素(P<0.05)。结论心房颤动、既往�Objective To analyze the risk factors of the 90 d prognosis in patients with acute cerebral infarction after intravenous thrombolysis therapy.Methods A total of 187 patients with acute cerebral infarction who received intravenous thrombolytic therapy with recombinent tissue-type plasminogen activator from Jan.2019 to Mar.2022 in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.The basic clinical data,laboratory tests,imaging examinations and modified Rankin scale(mRS)scores at 90 d after stroke were analyzed.According to the 90 d mRS score,the patients were divided into a good prognosis group(mRS score 0-2)and a poor prognosis group(mRS score 3-6).Univariate analysis and binary Logistic stepwise regression analysis were used to analyze the risk factors affecting the 90 d prognosis of the patients.Results 90 days after onset,112 of 187 patients had good prognosis and 75 had poor prognosis.Compared with the good prognosis group,the age>72 years old,the National Institutes of Health stroke scale(NIHSS)score on admission>6,the ratio of neutrophils and lymphocytes>2.55,the high-sensitivity cardiac troponin I(hs-cTnI)>0.006μg/L,creatine kinase isoenzyme>1.70μg/L,fasting glucose>5.81 mmol/L,as well as proportion of female patients and patients with hypertention,coronary heart disease,atrial fibrillation,history of previous stroke in poor prognosis group were higher[61.3%(46/75)vs 37.5%(42/112),61.3%(46/75)vs 29.5%(33/112),58.7%(44/75)vs 43.8%(49/112),62.7%(47/75)vs 38.4%(43/112),58.7%(44/75)vs 43.8%(49/112),61.3%(46/75)vs 42.0%(47/112),33.3%(25/75)vs 17.0%(19/112),84.0%(63/75)vs 66.1%(74/112),21.3%(16/75)vs 8.0%(9/112),34.7%(26/75)vs 14.3%(16/112),24.0%(18/75)vs 12.5%(14/112)](P<0.05 or P<0.01).There were no significant differences in the proportion of patients with diabetes and smoking,time from admission to thrombolysis therapy,systolic blood pressure,diastolic blood pressure,international normalized ratio,platelet count,creatinine,high d

关 键 词：急性脑梗死 静脉溶栓 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]