脑梗死合并新型冠状病毒感染患者早期神经功能恶化的影响因素分析  

Analysis of the impact factors on early neurological deterioration in patients with cerebral infarction combined with coronavirus disease 2019

作　　者：马志 姜海波[1] 蓝文雅[1] 许丽丽 杜明洋[1] 曹辉[1] 邱峰[1] MA Zhi;JIANG Haibo;LAN Wenya(Cerebrovascular Disease Center,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院脑血管病救治中心,210029

出　　处：《临床神经病学杂志》2024年第2期97-101,共5页Journal of Clinical Neurology

基　　金：南京市医学科技发展资金(QRX17086);南京市医学科技发展专项资金重点项目(ZKX23039)。

摘　　要：目的探究影响脑梗死合并新型冠状病毒感染(COVID-19)患者早期神经功能恶化的相关因素。方法回顾性分析2022年12月15日至2023年1月15日在南京医科大学附属脑科医院收治的脑梗死合并COVID-19患者的临床资料,根据早期神经功能是否恶化分为进展组和非进展组,比较两组之间临床特征的差异。结果本研究共纳入56例符合入组标准的患者,其中进展组16例,非进展组40例。进展组年龄[(74.31±12.04)岁]高于非进展组[(67.18±8.15)岁](P<0.05),既往有冠心病史和糖尿病史的比例较非进展组更高(均P<0.05)。在实验室检查指标中,进展组的单核细胞计数、C反应蛋白、糖化血红蛋白、乳酸脱氢酶、肌红蛋白、白蛋白、D-二聚体、纤维蛋白降解产物明显高于非进展组(均P<0.05)。二元Logistic回归分析结果显示C反应蛋白是脑梗死合并COVID-19的独立危险因素(OR=1.084,95%CI:1.002~1.173,P<0.05),ROC曲线下面积为0.825(95%CI:0.709~0.941,P<0.001)。结论脑梗死合并COVID-19早期神经功能恶化更容易发生于年龄较大、合并多种基础疾病、凝血和炎症指标异常的患者中,C反应蛋白增高具有良好的预测能力。Objective To explore the impact factors on early neurological deterioration(END)in patients with cerebral infarction combined with coronavirus disease 2019(COVID-19).Methods The clinical characteristics and laboratory of patients with acute ischemic stroke and COVID-19 in Brain Hospital Affiliated to Nanjing Medical University were retrospectively analyzed from December 15,2022 to January 15,2023.According to whether or not END occurred,all patients were divided into END group and non-END group.The clinical data of two groups were analyzed.Results A total of eligible 56 patients were included in this study,with 16 cases in END group and 40 cases in non-END group.The average age of END group(74.31±12.04)was older than non-END group(67.18±8.15)(P<0.05).The proportion of previous history of coronary heart disease and diabetes were higher than non-END group(all P<0.05).In terms of laboratory examination,the number of monocytes,C-reactive protein,glycated hemoglobin,lactate dehydrogenase,myoglobin,albumin,D-dimer,and fibrin degradation products in END group were significantly higher than that in non-END group(all P<0.05).Logistic analysis showed that C-reactive protein is an independent risk factor for cerebral infarction combined with COVID-19(OR=1.084,95%CI:1.002-1.173,P<0.05).Area under the R0C curve was 0.825(95%CI:0.709-0.941,P<0.001).Conclusions For patients with cerebral infarction combined with COVID-19,early neurological deterioration is more likely to occur in elderly patients with multiple underlying diseases,abnormal coagulation and inflammation indicators.Increased C-reactive protein has good predictive ability.

关 键 词：急性脑梗死 新型冠状病毒感染 C反应蛋白 D-二聚体 

分 类 号：R743.3[医药卫生—神经病学与精神病学]