基线血红蛋白水平对急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的影响  

Association between baseline hemoglobin level and early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：王庭欢 钟晚思 陈智才[1] 沈轲[3] 叶惠雅[3] 喻志慧 罗佳[3] 马骏[3] 楼敏[1] WANG Tinghuan;ZHONG Wansi;CHEN Zhicai;SHEN Ke;YE Huiya;YUZhihui;LUO Jia;MA Jun;LOU Min(Department of Neurology,the SecondAffiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Neurology,the First People’s Hospital of Jiashan County,Jiaxing314100,Zhejiang Province,China;Department of Neurology,Shaoxing HospitalAffiliated to China Medical University,Shaoxing 312099,Zhejiang Province,China)

机构地区：[1]浙江大学医学院附属第二医院神经内科,浙江杭州310009 [2]嘉善县第一人民医院神经内科,浙江嘉兴314100 [3]中国医科大学附属绍兴医院神经内科,浙江绍兴312099

出　　处：《浙江大学学报（医学版）》2024年第2期168-174,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(81971101,82171276)。

摘　　要：目的:探索急性缺血性脑卒中(AIS)患者基线血红蛋白水平与静脉溶栓后早期神经功能恶化(END)的相关性。方法:收集急性卒中质量评估与管理在线数据库(来源于CASE-Ⅱ研究,NCT04487340)中2017年1月至2020年7月在全国多家医院接受静脉溶栓治疗的AIS患者资料。采用二元logistic回归分析研究患者静脉溶栓治疗后发生END的影响因素,采用限制性三次样条曲线探讨血红蛋白水平与END之间的相关性。结果:共纳入8162例患者。与非END患者比较,END患者基线血红蛋白水平更低(分别为136与140 g/L,P<0.01),贫血比率更高(分别为24.2%与16.9%,P<0.01)。二元logistic回归分析显示,基线血红蛋白水平(OR=0.995,95%CI:0.991~0.999,P<0.05)和贫血(OR=1.238,95%CI:1.055~1.454,P<0.01)与AIS患者静脉溶栓后发生END独立相关。限制性三次样条回归结果显示,血红蛋白水平与AIS患者静脉溶栓后END风险呈U型关系(P<0.01),但这种U型关系只在男性患者中观察到(P<0.05)。结论:基线血红蛋白水平与AIS患者静脉溶栓治疗后END发生风险相关,特别是男性患者,血红蛋白水平降低或升高均可能增加END发生的风险。Objective:To investigate the association between baseline hemoglobin level and early neurologic deterioration(END)after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods:Data of AIS patients who received intravenous thrombolytic therapy at multiple hospitals across the country between January 2017 and July 2020 were collected from the online database Acute Stroke Patients for Stroke Management Quality Evaluation(CASE-Ⅱ,NCT04487340).Binary logistic regression analysis was used to study the factors affecting the occurrence of END after intravenous thrombolytic therapy,and the correlation between baseline hemoglobin level and END was investigated by limiting cubic spline curve analysis.Results:A total of 8162 patients were included.Patients with END had lower baseline hemoglobin levels(136 and 140 g/L,P<0.01)and higher rates of anemia(24.2%and 16.9%,P<0.01)compared with non�END patients.Binary logistic regression analysis showed that baseline hemoglobin level(OR=0.995,95%CI:0.991-0.999,P<0.05)and anemia(OR=1.238,95%CI:1.055-1.454,P<0.01)were independently correlated with the occurrence of END after intravenous thrombolysis in AIS patients.Restricted cubic spline regression showed that there was a U-shaped relationship between hemoglobin level and the risk of END after intravenous thrombolysis in AIS patients(P<0.01),although this relationship was only significant in male patients(P<0.05)and not in female patients(P>0.05).Conclusion:There is a correlation between baseline hemoglobin level and the risk of END in AIS patients after intravenous thrombolysis,especially in male patients,in whom both lower and higher hemoglobin level may increase the risk of END.

关 键 词：急性缺血性脑卒中 静脉溶栓 血红蛋白 贫血 早期神经功能恶化 回顾性研究 

分 类 号：R743[医药卫生—神经病学与精神病学]