中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
7期
995-999
,共5页
缺血性脑卒中%死亡%危险因素%D-二聚体%高敏C反应蛋白
缺血性腦卒中%死亡%危險因素%D-二聚體%高敏C反應蛋白
결혈성뇌졸중%사망%위험인소%D-이취체%고민C반응단백
Ischemic stroke%Death%Risk factors%D-dimer%High sensitivity C-reactive protein
目的 探讨老年急性缺血性脑卒中住院患者死亡相关危险因素,并研究D-二聚体和高敏C反应蛋白(hs-CRP)对老年缺血性脑卒中患者预后的评估价值.方法 对2010年9月至2013年9月北京安贞医院神经科收治的886例老年缺血性脑卒中患者的入院时血压、血糖、体温、血hs-CRP、D-二聚体等实验室指标及美国国立卫生院卒中量表(NIHSS)评分、Glasgow评分、既往病史、合并症等因素进行回顾性分析,以住院30 d内死亡为结局,对影响死亡的因素进行单因素和多因素Logistic回归分析.结果 886例老年缺血性脑卒中患者中死亡43例,病死率为4.8％.死亡患者与生存患者年龄、入院时血hs-CRP、D-二聚体、尿素氮、白蛋白、纤维蛋白原、有合并症比例、NIHSS评分、Glasgow评分等差异均有统计学意义[(75±10)岁比(70±10)岁,(8.8±2.0) mg/L比(5.2±1.0) mg/L,(1.73±0.92) mg/L比(1.04±0.28)mg/L,(9.6 ±5.1) mmol/L比(6.2±2.2) mmol/L,(37±5)g/L比(42±5)g/L,(4.6±1.7)g/L比(4.1±1.2)g/L,79.1％(34/43)比8.2％ (69/843),(16.3±7.2)分比(7.1±5.3)分,(8.0±3.3)分比(12.0±2.6)分](P＜0.05或P＜0.01).经多因素Logistic回归分析,结果提示患者入院时Glasgow评分高为保护性因素[比值比(OR)=0.642,95％置信区间(CI):-0.730～0.893].入院时血hs-CRP(OR=1.243,95％ CI:1.012 ～1.523)、D-二聚体(OR=2.231,95％CI:1.426 ～4.117、NIHSS评分(OR=1.226,95％ CI:1.112～ 1.412)及合并症(OR=65.03,95％ CI:11.433 ～363.626)均为老年急性缺血性脑卒中死亡的独立危险因素.结论 老年缺血性脑卒中死亡危险因素有患者年龄大、入院时hs-CRP升高、D-二聚体升高、NIHSS评分高、Glasgow评分低及入院时合并症.
目的 探討老年急性缺血性腦卒中住院患者死亡相關危險因素,併研究D-二聚體和高敏C反應蛋白(hs-CRP)對老年缺血性腦卒中患者預後的評估價值.方法 對2010年9月至2013年9月北京安貞醫院神經科收治的886例老年缺血性腦卒中患者的入院時血壓、血糖、體溫、血hs-CRP、D-二聚體等實驗室指標及美國國立衛生院卒中量錶(NIHSS)評分、Glasgow評分、既往病史、閤併癥等因素進行迴顧性分析,以住院30 d內死亡為結跼,對影響死亡的因素進行單因素和多因素Logistic迴歸分析.結果 886例老年缺血性腦卒中患者中死亡43例,病死率為4.8％.死亡患者與生存患者年齡、入院時血hs-CRP、D-二聚體、尿素氮、白蛋白、纖維蛋白原、有閤併癥比例、NIHSS評分、Glasgow評分等差異均有統計學意義[(75±10)歲比(70±10)歲,(8.8±2.0) mg/L比(5.2±1.0) mg/L,(1.73±0.92) mg/L比(1.04±0.28)mg/L,(9.6 ±5.1) mmol/L比(6.2±2.2) mmol/L,(37±5)g/L比(42±5)g/L,(4.6±1.7)g/L比(4.1±1.2)g/L,79.1％(34/43)比8.2％ (69/843),(16.3±7.2)分比(7.1±5.3)分,(8.0±3.3)分比(12.0±2.6)分](P＜0.05或P＜0.01).經多因素Logistic迴歸分析,結果提示患者入院時Glasgow評分高為保護性因素[比值比(OR)=0.642,95％置信區間(CI):-0.730～0.893].入院時血hs-CRP(OR=1.243,95％ CI:1.012 ～1.523)、D-二聚體(OR=2.231,95％CI:1.426 ～4.117、NIHSS評分(OR=1.226,95％ CI:1.112～ 1.412)及閤併癥(OR=65.03,95％ CI:11.433 ～363.626)均為老年急性缺血性腦卒中死亡的獨立危險因素.結論 老年缺血性腦卒中死亡危險因素有患者年齡大、入院時hs-CRP升高、D-二聚體升高、NIHSS評分高、Glasgow評分低及入院時閤併癥.
목적 탐토노년급성결혈성뇌졸중주원환자사망상관위험인소,병연구D-이취체화고민C반응단백(hs-CRP)대노년결혈성뇌졸중환자예후적평고개치.방법 대2010년9월지2013년9월북경안정의원신경과수치적886례노년결혈성뇌졸중환자적입원시혈압、혈당、체온、혈hs-CRP、D-이취체등실험실지표급미국국립위생원졸중량표(NIHSS)평분、Glasgow평분、기왕병사、합병증등인소진행회고성분석,이주원30 d내사망위결국,대영향사망적인소진행단인소화다인소Logistic회귀분석.결과 886례노년결혈성뇌졸중환자중사망43례,병사솔위4.8％.사망환자여생존환자년령、입원시혈hs-CRP、D-이취체、뇨소담、백단백、섬유단백원、유합병증비례、NIHSS평분、Glasgow평분등차이균유통계학의의[(75±10)세비(70±10)세,(8.8±2.0) mg/L비(5.2±1.0) mg/L,(1.73±0.92) mg/L비(1.04±0.28)mg/L,(9.6 ±5.1) mmol/L비(6.2±2.2) mmol/L,(37±5)g/L비(42±5)g/L,(4.6±1.7)g/L비(4.1±1.2)g/L,79.1％(34/43)비8.2％ (69/843),(16.3±7.2)분비(7.1±5.3)분,(8.0±3.3)분비(12.0±2.6)분](P＜0.05혹P＜0.01).경다인소Logistic회귀분석,결과제시환자입원시Glasgow평분고위보호성인소[비치비(OR)=0.642,95％치신구간(CI):-0.730～0.893].입원시혈hs-CRP(OR=1.243,95％ CI:1.012 ～1.523)、D-이취체(OR=2.231,95％CI:1.426 ～4.117、NIHSS평분(OR=1.226,95％ CI:1.112～ 1.412)급합병증(OR=65.03,95％ CI:11.433 ～363.626)균위노년급성결혈성뇌졸중사망적독립위험인소.결론 노년결혈성뇌졸중사망위험인소유환자년령대、입원시hs-CRP승고、D-이취체승고、NIHSS평분고、Glasgow평분저급입원시합병증.
Objective To discuss the death related factors of elderly patients with ischemic stroke and to evaluate the value of D-dimer and high sensitivity C-reactive protein(hs-CRP) on the prognosis in elderly patients with ischemic stroke.Methods Totally 886 consecutive ischemic stroke cases were retrospectively collected.The relevant factors of death,including admission blood pressure (systolic pressure and diastolic pressure),blood glucose,temperature,D-dimer,C-reactive protein,NIHSS total scores,Glasgow scores,the infarction site and degree of artery stenosis were analyzed.Death within 30 days was the endpoint.The risk factors were analyzed by univariate and multivariate Logistic regression.Results Totally 43 cases (4.8％) died in hospital.The differences of age,D-dimer,hs-CRP,urea nitrogen,albumin,fibrinogen,the proportion of complication,admission NIHSS total scores and admission Glasgow scores between the two groups had significance [(75 ± 10) years old vs (70 ±10)years old,(8.8 ±2.0)mg/L vs (5.2 ± 1.0) mg/L,(1.73 ±0.92) mg/L vs (1.04 ±0.28)mg/L,(9.6 ±5.1)mmol/Lvs (6.2±2.2)mmol/L,(37±5)g/L vs (42±5)g/L,(4.6±1.7)g/L vs (4.1 ±1.2)g/L,79.1％ (34/43) vs 8.2％ (69/843),(16.3 ± 7.2) scores vs (7.1 ± 5.3) scores,(8.0 ± 3.3) scores vs (12.0 ±2.6) scores] (P ＜0.05 or P ＜ 0.01).Multivariate Logistic regression analysis showed that Glasgow score was a protective factor[odds ratio(OR) =0.642,95％ confidence interval (CI):-0.730-0.893] of the patients.hsCRP (OR =1.243,95％ CI:1.012-1.523),D-dimer (OR =2.231,95％ CI:1.426-4.117),admission NIHSS total scores (OR =1.226,95 ％ CI:1.112-1.412) and complications [OR =65.03,95 ％ CI:11.433-363.626]were independent risk factors among elderly patients with acute ischemic stroke.Conclusion Old age,complications,D-dimer,hs-CPR,admission NIHSS total scores and admission Glasgow scores are independent risk factors of poor outcomes of ischemic stroke.
