应激性高血糖比值和低灌注体积预测前循环大血管闭塞性轻型卒中患者早期神经功能恶化  

Stress hyperglycemia ratio and hypoperfusion volume predict early neurological deterioration in patients with minor stroke due to large vessel occlusion in anterior circulation

作　　者：曹丽丹 刘铭 李震铎 陈科春 Cao Lidan;Liu Ming;Li Zhenduo;Chen Kechun(Department of Neurology,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang 215600,China)

机构地区：[1]苏州大学附属张家港医院(张家港市第一人民医院)神经内科,苏州215600

出　　处：《国际脑血管病杂志》2024年第11期814-820,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨应激性高血糖比值(stress hyperglycemia ratio,SHR)和低灌注体积对前循环大血管闭塞所致轻型卒中患者早期神经功能恶化(early neurological deterioration,END)的预测价值。方法:回顾性纳入苏州大学附属张家港医院神经内科在2021年10月至2024年1月期间连续收治的前循环大血管闭塞所致轻型卒中患者。轻型卒中定义为基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤5分。SHR计算为空腹血糖/糖化血红蛋白比值,CT灌注成像Tmax>6 s体积代表严重低灌注体积。END定义为发病24 h内NIHSS评分较基线增加≥4分。应用多变量logistic回归分析确定END的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线确定各独立预测因素对END的预测价值。结果:共纳入190例患者,女性52例(27.4%),年龄(65.89±14.30)岁;基线NIHSS评分3分(四分位数间距2~5分)。46例(24.2%)发生END,22例接受补救性血管内治疗。单变量分析显示,END组严重低灌注体积、SHR以及空腹血糖>7 mmol/L的患者比例与非END组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,SHR[优势比(odds ratio,OR)7.736,95%置信区间(confidence interval,CI)1.082~55.286;P=0.041]和Tmax>6 s体积(OR 1.006,95%CI 1.001~1.010;P=0.009)是END的独立预测因素。ROC曲线分析显示,SHR和Tmax>6 s体积预测END的曲线下面积分别为0.720(95%CI 0.632~0.807)和0.649(95%CI 0.561~0.737),SHR的最佳截断值为1.03,敏感性和特异性分别为60.9%和79.9%;Tmax>6 s体积的最佳截断值为38.7 ml,敏感性和特异性分别为89.1%和39.6%。两者联合预测END的曲线下面积为0.736(95%CI 0.654~0.848)。结论:在前循环大血管闭塞所致轻型卒中患者中,较高的SHR和较大的严重低灌注体积对END有一定的预测价值。Objective:To investigate the predictive value of stress hyperglycemic ratio(SHR)and hypoperfusion volume for early neurological deterioration(END)in patients with minor stroke due to large vessel occlusion in anterior circulation.Methods:Consecutive patients with minor stroke due to large vessel occlusion in anterior circulation admitted to the Department of Neurology,Zhangjiagang Hospital Affiliated to Soochow University from October 2021 to January 2024 were included retrospectively.Minor stroke was defined as a baseline National Institutes of Health Stroke Scale(NIHSS)score of≤5.SHR was calculated as the fasting blood glucose to glycated hemoglobin ratio,and CT perfusion imaging Tmax>6 s volume represented severe hypoperfusion volume.END was defined as an increase of≥4 in NIHSS score compared to the baseline within 24 hours of onset.Multivariate logistic regression analysis was used to determine the independent risk factors for END.Receiver operating characteristic(ROC)curves was used to determine the predictive value of each independent predictor for END.Results:A total of 190 patients were enrolled,including 52 females(27.4%),aged 65.89±14.30 years.The baseline NIHSS score was 3(interquartile range,2-5).Forty-six patients(24.2%)experienced END,and 22 received salvage endovascular treatment.Univariate analysis showed that there were significant differences in severe hypoperfusion volume,SHR,and the proportion of patients with fasting blood glucose>7 mmol/L between the END group and the non-END group(all P<0.05).Multivariate logistic regression analysis showed that SHR(odds ratio[OR]7.736,95%confidence interval[CI]1.082-55.286;P=0.041)and Tmax>6 s volume(OR 1.006,95%CI 1.001-1.010;P=0.009)were the independent predictive factors for END.ROC curve analysis showed that area under the curve of SHR and Tmax>6 s volume for predicting END were 0.720(95%CI 0.632-0.807)and 0.649(95%CI 0.561-0.737),respectively.The optimal cutoff value for SHR was 1.03,and the sensitivity and specificity were 60.9%and 79.9%,respect

关 键 词：缺血性卒中 疾病严重程度指数 疾病恶化 血糖 糖化血红蛋白 灌注成像 体层摄影术 X线计算机 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]