急性前循环大血管闭塞性轻型卒中行单纯药物治疗患者早期神经功能恶化的影响因素分析  

Analysis of influencing factors of early neurological deterioration in patients with acute anterior circulation large-vessel occlusive mild stroke

作　　者：孙洪扬 李旭华[1] 周娟 李云杰[1] 武津成 韩红星[1] 王贤军[1] 赵振宇[1] Sun Hongyang;Li Xuhua;Zhou Juan;Li Yunjie;Wu Jincheng;Han Hongxing;Wang Xianjun;Zhao Zhenyu(Department of Neurology,Linyi People′s Hospital,Linyi,Shandong 276000,China)

机构地区：[1]山东省临沂市人民医院神经内科,276000 [2]山东省临沂市人民医院医学影像科

出　　处：《中国脑血管病杂志》2025年第2期81-88,104,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：山东省医药卫生科技项目(202403070343)。

摘　　要：目的 探讨急性前循环大血管闭塞性轻型卒中行单纯药物治疗患者发病72 h内发生早期神经功能恶化(END)的影响因素。方法 回顾性连续纳入2021年1月至2022年12月于临沂市人民医院高级卒中中心就诊的发病24 h内的急性大血管闭塞性轻型卒中患者。将发病72 h内美国国立卫生研究院卒中量表(NIHSS)评分较入院时增加≥4分定义为END,并根据是否发生END分为功能恶化组和病情稳定(发病72 h内NIHSS评分较入院时无增加或增加1~3分)组。收集所有患者的基线及临床资料,包括性别、年龄、脑血管病危险因素(高血压病、糖尿病、高脂血症、冠心病、心房颤动、吸烟史、饮酒史、卒中史)、入院时NIHSS评分、发病至入院时间、入院时收缩压、入院时舒张压、入院时实验室检查指标(血糖、糖化血红蛋白、同型半胱氨酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、中性粒细胞、淋巴细胞、中性粒细胞/淋巴细胞比值)、责任闭塞血管(颈内动脉、大脑中动脉、大脑前动脉)、病变大脑半球、侧支循环评分、入院72 h内治疗用药情况(静脉溶栓+双抗、替罗非班+双抗、阿加曲班+双抗、单纯阿加曲班、单纯双抗)等。将单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析,探讨急性前循环大血管闭塞性轻型卒中行单纯药物治疗患者发生END的独立影响因素。结果 共纳入208例急性前循环大血管闭塞性轻型卒中患者,男143例,女65例,年龄38~85岁,平均(64±9)岁。其中功能恶化组86例,病情稳定组122例。(1)功能恶化组与病情稳定组糖尿病[39.5%(34/86)比17.2%(21/122)]、吸烟史[43.0%(37/86)比29.5%(36/122)]、左侧大脑半球病变[57.0%(49/86)比41.0%(50/122)]患者比例及侧支循环评分[4(3,5)分比5(4,5)分]、发病至入院时间[7.0(3.0,17.0)h比4.3(2.0,11.0)h]、入院时血糖[7.4(5.8,10.0)mmol/L比6.7(5.8,7Objective To explore the influencing factors of early neurological deterioration(END)in patients with acute anterior circulation large-vessel occlusive mild stroke who were treated with medications alone within 72 h after onset.Methods Retrospective consecutive data were collected of patients with acute large-vessel occlusive mild stroke who presented to the Advanced Stroke Center of Linyi People′s Hospital within 24 h of onset from January 2021 to December 2022.END was defined as an increase of≥4 points in the National Institutes of Health stroke scale(NIHSS)score within 72 h after onset compared to the admission score.Patients were divided into the neurological deterioration group and the stable condition group(NIHSS score did not increase or increased by 1-3 points within 72 h after onset compared to the admission score).Baseline and clinical data of all patients were collected,including sex,age,cerebrovascular disease risk factors(hypertension,diabetes mellitus,hyperlipidemia,coronary heart disease,atrial fibrillation,smoking,alcohol consumption,stroke history),NIHSS score at admission,time from onset to admission,systolic blood pressure at admission,diastolic blood pressure at admission,laboratory test indicators at admission(blood glucose,glycosylated hemoglobin,homocysteine,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,neutrophils,lymphocytes and neutrophil-to-lymphocyte ratio),responsible occlusion artery(internal carotid artery,middle cerebral artery,anterior cerebral artery),affected cerebral hemisphere,collateral circulation score,and medications used within 72 h after admission(intravenous thrombolysis+dual antiplatelet therapy,tirofiban+dual antiplatelet therapy,argatroban+dual antiplatelet therapy,argatroban alone,dual antiplatelet therapy alone).Variables with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to explore the independent influencing factors for END in pa

关 键 词：急性轻型卒中 神经功能恶化 大血管闭塞 前循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]