大脑中动脉闭塞所致轻型卒中患者早期神经功能恶化的危险因素及其预测价值  

Risk factors and predictive value of early neurological deterioration in patients with minor stroke caused by middle cerebral artery occlusion

作　　者：陈科春 徐周 张雯君 郭刚 刘慧慧[2] Chen Kechun;Xu Zhou;Zhang Wenjun;Guo Gang;Liu Huihui(Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang 215600,China;Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属张家港医院,苏州215600 [2]苏州大学附属第二医院神经内科,苏州215004

出　　处：《国际脑血管病杂志》2023年第9期647-651,共5页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(82071310)。

摘　　要：目的探讨大脑中动脉闭塞所致轻型卒中患者发生早期神经功能恶化(early neurological deterioration,END)的危险因素及其预测价值。方法回顾性纳入苏州大学附属张家港医院2021年10月至2023年5月连续收治的大脑中动脉闭塞所致轻型卒中患者。轻型卒中定义为入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤5分,END定义为入院24 h内NIHSS评分较基线增加≥4分(排除颅内出血)。应用多变量logistic回归分析确定END的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评估各危险因素对END的预测价值。结果共纳入130例大脑中动脉主干闭塞所致轻型卒中患者,33例(25.4%)发生END,97例(74.6%)未发生END。单变量分析显示,END组与非END组入院NIHSS评分、脑血流量<30%体积、CT灌注不匹配体积、基线血糖和基线白细胞计数均差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,CT灌注不匹配体积[优势比(odds ratio,OR)1.010,95%置信区间(confidence interval,CI)1.003~1.017;P=0.007]和基线白细胞计数(OR 1.582,95%CI 1.200~2.085;P=0.001)是END的独立危险因素。ROC曲线分析显示,CT灌注不匹配体积和基线白细胞计数预测END的曲线下面积分别为0.748(95%CI 0.660~0.835;P<0.001)和0.757(95%CI 0.659~0.854;P<0.001),两者联合预测END的曲线下面积为0.821(95%CI 0.738~0.905;P<0.001)。结论CT灌注不匹配体积和基线白细胞计数是合并大脑中动脉闭塞的轻型卒中患者发生END的独立危险因素,两者联合对END具有较好的预测价值。Objective To investigate the risk factors and predictive value of early neurological deterioration(END)in patients with minor stroke caused by middle cerebral artery occlusion.Methods Consecutive patients with minor stroke caused by middle cerebral artery occlusion admitted to Zhangjiagang Hospital Affiliated to Soochow University from October 2021 to May 2023 were retrospectively included.Minor stroke was defined as the National Institutes of Health Stroke Scale(NIHSS)score≤5 at admission,and END was defined as an increase of≥4 from baseline in the NIHSS score within 24 h of admission(excluding intracranial hemorrhage).Multivariate logistic regression analysis was used to determine independent risk factors for END.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of various risk factors on END.Results A total of 130 patients with minor stroke caused by middle cerebral artery occlusion were included,of which 33(25.4%)had END and 97(74.6%)did not.Univariate analysis showed that there were statistically significant differences in NIHSS scores,volume with cerebral blood flow<30%,CT perfusion mismatch volume,baseline blood glucose,and baseline white blood cell count between the END and non-END groups(all P<0.05).Multivariate logistic regression analysis showed that CT perfusion mismatch volume(odds ratio[OR]1.010,95%confidence interval[CI]1.003-1.017;P=0.007)and baseline white blood cell count(OR 1.582,95%CI 1.200-2.085;P=0.001)were the independent risk factors for END.ROC curve analysis showed that the area under the curves of CT perfusion mismatch volume and baseline white blood cell count for predicting END were 0.748(95%CI 0.660-0.835;P<0.001)and 0.757(95%CI 0.659-0.854;P<0.001),respectively.The area under the curve of combined predicting END was 0.821(95%CI 0.738-0.905;P<0.001).Conclusions CT perfusion mismatch volume and baseline white blood cell count are independent risk factors for the occurrence of END patients with minor stroke caused by middle cerebral artery occlus

关 键 词：缺血性卒中 梗塞 大脑中动脉 疾病严重程度指数 疾病恶化 灌注成像 体层摄影术 X线计算机 大脑中动脉闭塞 危险因素 试验预期值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]