急性前庭综合征患者脑梗死的临床特征及相关因素分析  

Clinical Characteristics and Related Factors of Patients with Cerebral Infarction in Acute Vestibular Syndrome

作　　者：张春悦 方力群[2] ZHANG Chunyue;FANG Liqun(Department of Neurology,the Second Hospital of Heilongjiang Province,Harbin 150000,China;Department of Neurology,the Fourth Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]黑龙江省第二医院神经内科,黑龙江省哈尔滨市150000 [2]哈尔滨医科大学附属第四医院神经内科,黑龙江省哈尔滨市150000

出　　处：《中国全科医学》2024年第14期1678-1684,共7页Chinese General Practice

摘　　要：背景急性脑梗死是急性前庭综合征中较为危重的疾病。急性前庭综合征患者起病急,症状重,CT诊断急性脑梗死的灵敏度低,而核磁共振检查又不易立即实施,这使得表现为急性前庭综合征的急性脑梗死诊断具有一定挑战性,因此有必要探究适用于急性前庭综合征患者的检查和评价方法。目的分析急性前庭综合征患者中急性脑梗死发生的相关危险因素,为急性前庭综合征中急性脑梗死的诊断提供借鉴,争取急性脑梗死患者的黄金治疗时间。方法收集2021年4月—2022年7月就诊于哈尔滨医科大学附属第四医院神经内科急性前庭综合征患者102例,录入相关临床体征,以核磁共振检查结果作为脑梗死诊断的金标准,分为脑梗死组(16例)与非脑梗死组(86例),对比两组患者临床特点,采用单因素和多因素Logistic回归分析探究急性前庭综合征中脑梗死发生的相关影响因素,并绘制受试者工作特征(ROC)曲线评价相关影响因素对脑梗死的预测价值。结果脑梗死组患者吸烟史、饮酒史、头脉冲试验-眼震-眼位偏斜试验(HINTS)阳性比例、ABCD2评分均高于非脑梗死组(P<0.05)。单因素Logistic回归分析显示HINTS阳性、ABCD2评分、吸烟史、饮酒史、听力下降是脑梗死发生的影响因素(P<0.05),多因素Logistic回归分析显示HINTS阳性(OR=99.043,95%CI=8.120~1208.090)和ABCD2评分(OR=2.820,95%CI=1.188~6.696)是脑梗死发生的影响因素(P<0.05)。多指标联合、HINTS阳性、ABCD2评分、吸烟史、饮酒史、听力下降预测脑梗死的ROC曲线下面积(AUC)为0.949、0.874、0.734、0.643、0.649和0.604。结论急性前庭综合征患者中非脑梗死比例较大,其中以前庭神经炎最常见,HINTS阳性和ABCD2评分与急性前庭综合征中脑梗死的发生密切相关。Background Acute cerebral infarction is a critical condition in patients with acute vestibular syndrome(AVS).AVS presents suddenly with severe symptoms.The sensitivity of CT in diagnosing acute cerebral infarction is low,and MRI,which is more accurate,is not always immediately available.This makes the diagnosis of acute cerebral infarction presenting as AVS challenging.Therefore,it is necessary to explore suitable examination and evaluation methods for patients with AVS.Objective To analyze the risk factors associated with acute cerebral infarction in patients with AVS,in order to provide a reference for the diagnosis of acute cerebral infarction in AVS and to maximize the critical treatment window for these patients.Methods A total of 102 patients with AVS admitted to the Department of Neurology,the Fourth Hospital of Harbin Medical University from April 2021 to July 2022 were included in the study.Clinical signs were recorded,and MRI results were used as the gold standard for the diagnosis of cerebral infarction.Patients were divided into the cerebral infarction group(n=16)and non-cerebral infarction group(n=86).The clinical characteristics of the two groups were compared.Univariate and multivariate Logistic regression analyses were used to explore factors influencing the occurrence of cerebral infarction in AVS.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of these factors.Results The proportions of patients with a history of smoking,alcohol consumption,positive Head-Impulse-Nystagmus-Test-of-Skew(HINTS)tests,and higher ABCD2 scores were significantly higher in the cerebral infarction group(P<0.05).Univariate Logistic regression analysis indicated that positive HINTS,ABCD2 scores,history of smoking,alcohol consumption,and hearing loss were factors influencing the occurrence of cerebral infarction.Multivariate analysis showed that positive HINTS(OR=99.043,95%CI=8.120-1208.090)and ABCD2 scores(OR=2.820,95%CI=1.188-6.696)were the influencing factors(P<0.05).The areas u

关 键 词：急性持续性头晕 急性前庭综合征 脑梗死 头脉冲试验-眼震-眼位偏斜试验 危险因素 

分 类 号：R741.041[医药卫生—神经病学与精神病学]