老年后循环缺血性卒中患者预后及危险因素分析  

Analysis of prognosis and risk factors in elderly patients with posterior circulation ischemia

作　　者：崔秀英 杨敏[2] 白海波 张沐源 张然[1] CUI Xiu-ying;YANG Min;BAI Hai-bo;ZHANG Mu-yuan;ZHANG Ran(Department of Neurology,Chengde Central Hospital,Hebei Province,Chengde 067000,China;Department of Emergency,Chengde Central Hospital,Hebei Province,Chengde 067000,China;Department of Neurosurgery,Staff Hospital of Chengde Iron and Steel Group Co.,Ltd.,Hebei Province,Chengde 067100,China;Department of Radiology&Imaging,Chengde Central Hospital,Hebei Province,Chengde 067000,China)

机构地区：[1]河北省承德市中心医院神经内科,河北承德067000 [2]河北省承德市中心医院急诊科,河北承德067000 [3]承德钢铁集团有限公司职工医院神经外科,河北承德067100 [4]河北省承德市中心医院放射医学影像科,河北承德067000

出　　处：《河北医科大学学报》2024年第9期1025-1029,共5页Journal of Hebei Medical University

基　　金：承德市科学技术研究与发展计划(202002A010)。

摘　　要：目的探讨老年后循环缺血性卒中患者预后及危险因素。方法选取河北省承德市中心医院老年后循环缺血性卒中患者120例,根据治疗后3个月预后情况进行分组,分析预后不良和良好患者临床一般资料、外周血空腹血糖、糖化血红蛋白(hemoglobin A_(1)c,HbA_(1)c)等差异,总结老年后循环缺血性卒中患者预后的影响因素。结果预后不良患者39例,预后不良发生率为32.50%。预后不良组年龄和入院期间最高美国国立卫生研究所卒中量表(National Institute of Health Stroke Scale,NIHSS)评分分别为(68.93±4.02)岁和(19.30±2.50)分,高于预后良好组(P<0.05)。预后不良组空腹血糖、HbA_(1)c、脂蛋白相关磷脂酶a2(lipoprotein associated phospholipase A2,LP-PLA2)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)和血小板活化因子(platelet activating factor,PAF)分别为(7.28±0.92)mmol/L、(7.02±0.86)%、(330.50±65.53)μg/L、(20.22±6.43)ng/L和(248.23±44.18)ng/L,高于预后良好组(P<0.05)。Logistic回归分析,显示年龄、入院期间最高NIHSS评分、空腹血糖、LP-PLA2、PAF是患者预后的影响因素(P<0.05)。构建的方程预测预后不良的ROC曲线下面积为0.884(95%CI:0.821~0.948),P<0.05,敏感度和特异度分别为84.60%和81.50%。结论老年后循环缺血性卒中患者预后不良比例高,预后情况受患者年龄、入院期间最高NIHSS评分、空腹血糖、LP-PLA2、PAF的影响,同时由此构建的模型对患者预后不良具有较高的预测价值。Objective To explore the prognosis and risk factor of elderly patients with posterior circulation ischemia(PCI).Methods A total of 120 patients with PCI in Chengde Central Hospital were selected and grouped according to the prognosis at 3 months after treatment.The differences in clinical data,fasting peripheral blood glucose(FBG),and hemoglobin A1C(HbA_(1)c)between patients with poor prognosis and those with good prognosis were analyzed.Results There were 39 patients with poor prognosis,and the incidence of poor prognosis was 32.50%.The age of patients with poor prognosis and the highest National Institutes of Health Stroke Scale(NIHSS)score during admission were(68.93±4.02)years and(19.30±2.50)points,respectively,which were significantly higher than those with good prognosis(P<0.05).The FBG,HbA 1c,lipoprotein-associated phospholipase a2(Lp-PLA2),high-sensitivity C-reactive protein(hs CRP)and platelet activating factor(PAF)in poor prognosis group were(7.28±0.92)mmol/L,(7.02±0.86)%,(330.50±65.53)μg/L,(20.22±6.43)ng/L and(248.23±44.18)ng/L,respectively,which were significantly higher than those in good prognosis group(P<0.05).Logistic regression analysis showed that age,the highest NIHSS score during hospitalization,FBG,Lp-PLA2,and PAF were the prognostic factors of patients(P<0.05).The area under the receiver operating characteristic predicted by this equation for poor prognosis was 0.884(95%CI:0.821-0.948),(P<0.05),and the sensitivity and specificity were 84.60%and 81.50%,respectively.Conclusion The proportion of poor prognosis in elderly patients with PCI is high,and the prognosis is affected by the age of patients,the highest NIHSS score during hospitalization,FBG,Lp-PLA2,and PAF.Meanwhile,the model constructed by this method has high predictive value for the poor prognosis of patients.

关 键 词：缺血性卒中 后循环缺血 老年 

分 类 号：R743.3[医药卫生—神经病学与精神病学]