CAJ | 학술논문

目的：分析急性缺血性脑卒中（IS）进展的相关危险因素，并探讨血浆同型半胱氨酸（Hcy）检测联合ES-SEN评分对其预测作用。方法发病24 h内的急性IS患者126例，根据进展性脑卒中（ PS）定义分为PS组30例、非PS组96例。比较两组年龄、性别、高血压病史等，多因素分析急性IS进展为PS的相关危险因素。将所有患者以血浆Hcy≤15μmol/L和Hcy＞15μmol/L分为正常组和增高组，两组以ESSEN评分≤2分和＞2分再分为两组，以血浆Hcy≤15μmol/L且ESSEN评分＞2分的患者为基线组，其余组分别与之比较，评价IS进展为PS的发生风险。结果 PS组FIB水平、颈动脉不稳定斑块、颅内大动脉狭窄、吞咽障碍、血浆Hcy水平及ESSEN评分均高于非PS组（P均＜0．05），有糖尿病史例数低于非PS组（P＜0．05）；多因素分析表明，FIB水平、颅内大动脉狭窄、血浆Hcy水平及ESSEN评分是急性IS进展为PS的危险因素（P均＜0．05）。血浆Hcy＞15μmol/L且ESSEN评分＞2分的急性IS患者短期发展为PS的风险较高。结论 FIB水平、颅内大动脉狭窄、血浆Hcy水平及ESSEN评分等是急性IS发展为PS的危险因素，Hcy联合ESSEN评分对预测PS的价值较高。
목적：분석급성결혈성뇌졸중（IS）진전적상관위험인소，병탐토혈장동형반광안산（Hcy）검측연합ES-SEN평분대기예측작용。방법발병24 h내적급성IS환자126례，근거진전성뇌졸중（ PS）정의분위PS조30례、비PS조96례。비교량조년령、성별、고혈압병사등，다인소분석급성IS진전위PS적상관위험인소。장소유환자이혈장Hcy≤15μmol/L화Hcy＞15μmol/L분위정상조화증고조，량조이ESSEN평분≤2분화＞2분재분위량조，이혈장Hcy≤15μmol/L차ESSEN평분＞2분적환자위기선조，기여조분별여지비교，평개IS진전위PS적발생풍험。결과 PS조FIB수평、경동맥불은정반괴、로내대동맥협착、탄인장애、혈장Hcy수평급ESSEN평분균고우비PS조（P균＜0．05），유당뇨병사례수저우비PS조（P＜0．05）；다인소분석표명，FIB수평、로내대동맥협착、혈장Hcy수평급ESSEN평분시급성IS진전위PS적위험인소（P균＜0．05）。혈장Hcy＞15μmol/L차ESSEN평분＞2분적급성IS환자단기발전위PS적풍험교고。결론 FIB수평、로내대동맥협착、혈장Hcy수평급ESSEN평분등시급성IS발전위PS적위험인소，Hcy연합ESSEN평분대예측PS적개치교고。
Objective To analyze the risk factors of acute ischemic stroke ( IS) , and to investigate the combined de-tections of plasma homocysteine (Hcy) and ESSEN score in predicting progressive stroke (PS).Methods Totally 126 patients with acute IS of onset within 24 h were included .According to PS definition , patients were divided into the PS group (30 cases) and non-PS group (96 cases).The age, gender and history of hypertension in the two groups were com-pared.and multivariate analysis were used to assess the risk factors of acute IS developing into PS .According to Hcy level , all patients were divided into two groups:the normal group (≤15μmol/L) and the increased group (>15μmol/L) , and then according to ESSEN score ≤2 and >2, they were respectively divided into two groups .Hcy level ≤15μmol/L and ESSEN score >2 was designed as baseline , other groups were respectively compared with the baseline group to evolve the short-term risk of PS.Results Fibrinogen (FIB) level, unstable carotid plaque, intracranial artery stenosis, dysphagia, Hcy and ESSEN score were higher in the PS group than those in the non-PS group ( all P<0.05); the number of cases with diabetes history was less in the PS group than that of the non-PS group (P<0.05).Multivariate analysis showed that FIB level, intracranial artery stenosis , Hcy level and ESSEN score in the PS group were higher than those in the non-PS group (all P<0.05).Patients with Hcy level >15μmol/L and ESSEN score >2 had higher short-term risk of PS.Con-clusion FIB level, intracranial artery stenosis , Hcy level and ESSEN score are the risk factors of PS .Hcy combined with ESSEN score in predicting risk of PS has good predictive value .