中国脑血管病杂志
中國腦血管病雜誌
중국뇌혈관병잡지
CHINESE JOURNAL OF CEREBROVASCULAR DISEASES
2014年
11期
569-575
,共7页
脑梗死%C反应蛋白质%神经功能恶化%进展%责任动脉闭塞
腦梗死%C反應蛋白質%神經功能噁化%進展%責任動脈閉塞
뇌경사%C반응단백질%신경공능악화%진전%책임동맥폐새
Cerebralinfarction%C-reactiveprotein%Neurologicaldeterioration%Progression%Guilty artery occlusion
目的:探讨急性脑梗死早期进展发生的相关危险因素。方法回顾性分析2012年1月—2013年12月东南大学附属中大医院神经内科收治的急性脑梗死患者446例。神经功能恶化(ND)定义为住院72 h内任一时刻复评美国国立卫生研究卒中量表(NIHSS)评分较入院基线NIHSS评分增加2分(ND2)或增加4分(ND4)。将患者分为ND2组(n=107)和非ND2组(n=339),或ND4组(n=62)和非ND4组(n=384)。比较不同组间患者的一般人口学、脑血管病危险因素、影像学以及血液学资料的差异。结果446例患者中,107例(24.0%)诊断为ND2,62例(13.9%)诊断为ND4。单因素分析结果显示,ND2患者和非ND2患者间住院时间、年龄、基线NIHSS评分、入院基线收缩压、责任动脉闭塞以及血液学检查中的白细胞、空腹血糖和C反应蛋白水平差异均有统计学意义(均P<0.05);ND4患者和非ND4患者间性别、年龄、心房颤动、基线NIHSS评分、入院基线收缩压、责任动脉闭塞以及血液C反应蛋白水平的差异均有统计学意义(均P<0.05)。校正混杂因素后,Logistic回归分析结果显示,基线 NIHSS评分(OR =1.114,95%CI:1.0481~1.185,P=0.001)、C反应蛋白(OR=1.014,95%CI:1.004~1.024,P=0.004)、责任动脉闭塞(OR=2.303,95%CI:1.152~4.606,P=0.018)与ND2独立相关;而年龄(OR=1.040,95%CI:1.011~1.070, P=0.006)、收缩压(OR=1.015,95%CI:1.003~1.027,P=0.018)、C反应蛋白(OR=1.016,95%CI:1.005~1.026,P=0.003)、责任动脉闭塞(OR=2.845,95%CI:1.291~2.269,P=0.009)与ND4独立相关。结论急性脑梗死患者早期发生ND与患者年龄、卒中严重程度、基线收缩压、C反应蛋白以及责任动脉闭塞关系密切。临床诊治中,及时完善上述指标的检测有助于鉴别出早期易于进展恶化的急性脑梗死患者。
目的:探討急性腦梗死早期進展髮生的相關危險因素。方法迴顧性分析2012年1月—2013年12月東南大學附屬中大醫院神經內科收治的急性腦梗死患者446例。神經功能噁化(ND)定義為住院72 h內任一時刻複評美國國立衛生研究卒中量錶(NIHSS)評分較入院基線NIHSS評分增加2分(ND2)或增加4分(ND4)。將患者分為ND2組(n=107)和非ND2組(n=339),或ND4組(n=62)和非ND4組(n=384)。比較不同組間患者的一般人口學、腦血管病危險因素、影像學以及血液學資料的差異。結果446例患者中,107例(24.0%)診斷為ND2,62例(13.9%)診斷為ND4。單因素分析結果顯示,ND2患者和非ND2患者間住院時間、年齡、基線NIHSS評分、入院基線收縮壓、責任動脈閉塞以及血液學檢查中的白細胞、空腹血糖和C反應蛋白水平差異均有統計學意義(均P<0.05);ND4患者和非ND4患者間性彆、年齡、心房顫動、基線NIHSS評分、入院基線收縮壓、責任動脈閉塞以及血液C反應蛋白水平的差異均有統計學意義(均P<0.05)。校正混雜因素後,Logistic迴歸分析結果顯示,基線 NIHSS評分(OR =1.114,95%CI:1.0481~1.185,P=0.001)、C反應蛋白(OR=1.014,95%CI:1.004~1.024,P=0.004)、責任動脈閉塞(OR=2.303,95%CI:1.152~4.606,P=0.018)與ND2獨立相關;而年齡(OR=1.040,95%CI:1.011~1.070, P=0.006)、收縮壓(OR=1.015,95%CI:1.003~1.027,P=0.018)、C反應蛋白(OR=1.016,95%CI:1.005~1.026,P=0.003)、責任動脈閉塞(OR=2.845,95%CI:1.291~2.269,P=0.009)與ND4獨立相關。結論急性腦梗死患者早期髮生ND與患者年齡、卒中嚴重程度、基線收縮壓、C反應蛋白以及責任動脈閉塞關繫密切。臨床診治中,及時完善上述指標的檢測有助于鑒彆齣早期易于進展噁化的急性腦梗死患者。
목적:탐토급성뇌경사조기진전발생적상관위험인소。방법회고성분석2012년1월—2013년12월동남대학부속중대의원신경내과수치적급성뇌경사환자446례。신경공능악화(ND)정의위주원72 h내임일시각복평미국국립위생연구졸중량표(NIHSS)평분교입원기선NIHSS평분증가2분(ND2)혹증가4분(ND4)。장환자분위ND2조(n=107)화비ND2조(n=339),혹ND4조(n=62)화비ND4조(n=384)。비교불동조간환자적일반인구학、뇌혈관병위험인소、영상학이급혈액학자료적차이。결과446례환자중,107례(24.0%)진단위ND2,62례(13.9%)진단위ND4。단인소분석결과현시,ND2환자화비ND2환자간주원시간、년령、기선NIHSS평분、입원기선수축압、책임동맥폐새이급혈액학검사중적백세포、공복혈당화C반응단백수평차이균유통계학의의(균P<0.05);ND4환자화비ND4환자간성별、년령、심방전동、기선NIHSS평분、입원기선수축압、책임동맥폐새이급혈액C반응단백수평적차이균유통계학의의(균P<0.05)。교정혼잡인소후,Logistic회귀분석결과현시,기선 NIHSS평분(OR =1.114,95%CI:1.0481~1.185,P=0.001)、C반응단백(OR=1.014,95%CI:1.004~1.024,P=0.004)、책임동맥폐새(OR=2.303,95%CI:1.152~4.606,P=0.018)여ND2독립상관;이년령(OR=1.040,95%CI:1.011~1.070, P=0.006)、수축압(OR=1.015,95%CI:1.003~1.027,P=0.018)、C반응단백(OR=1.016,95%CI:1.005~1.026,P=0.003)、책임동맥폐새(OR=2.845,95%CI:1.291~2.269,P=0.009)여ND4독립상관。결론급성뇌경사환자조기발생ND여환자년령、졸중엄중정도、기선수축압、C반응단백이급책임동맥폐새관계밀절。림상진치중,급시완선상술지표적검측유조우감별출조기역우진전악화적급성뇌경사환자。
Objective Toinvestigatetherelatedriskfactorsofneurologicaldeterioration(ND)in patientswithacutecerebralinfarction.Methods Atotalof446patientswithacutecerebral infarction admitted to the Department of Neurology,Zhongda Hospital,Southeast University from January 2012 to December 2013 were analyzed retrospectively. ND was defined as the reevaluation of the National Institutes of Health Stroke Scale (NIHSS)scores at any time for the increased admission baseline score 2 (ND2)or 4 (ND4)within the first 72 hours. All subjects were divided into a ND2 group (n=107)and a non-ND2 group (n=339)or a ND4 group (n=62)and a non-ND4 group (n=384 ). The differences of general demography,vascular risk factors,imaging,and hematological dataamongthedifferentgroupswerecompared.Results Ofthe446patients,107cases(24.0%) were diagnosed as ND2 and 62 cases (13. 9%)were diagnosed as ND4. The result of univariate analysis showed that there were significant differences in the length of hospital stay,age,baseline NIHSS score,baseline systolic blood pressure on admission,guilty artery occlusion,and the levels of leukocyte,fasting glucose,and C-reactive protein between the ND2 patients and the non-ND2 patients (all P<0. 05). There were significant differences in sex,age,atrial fibrillation,baseline NIHSS score, baseline systolic blood pressure on admission,guilty artery occlusion,and the level of C-reactive protein between the ND4 patients and the non-ND4 patients (all P<0. 05). After adjustment for the confounding factors,the results of Logistic regression analysis showed that the baseline NIHSS score (OR,1.114, 95%CI 1. 0481-1.185,P=0. 001),C-reactive protein (OR,1. 014,95%CI 1. 004-1. 024,P=0. 004), and guilty artery occlusion (OR,2. 303,95%CI 1. 152-4. 606,P=0. 018)were independently correlated with ND2;while the age (OR,1. 040,95%CI 1. 011-1. 070,P=0. 006),systolic blood pressure (OR, 1.015,95%CI 1. 003-1. 027,P=0. 018),C-reactive protein (OR,1. 016,95%CI 1. 005-1. 026,P=0.003),and guilty artery occlusion (OR,2. 845,95%CI 1. 291-2. 269,P =0. 009)were independently correlatedwithND4.Conclusion TheearlyonsetofNDinpatientswithacutecerebralinfarctionare closely associated with age,stroke severity,baseline systolic blood pressure,C-reactive protein,and occlusion of guilty artery. In the clinical diagnosis and treatment,detecting the above indicators timely may contribute to identify the patients with acute cerebral infarction and early progressive deterioration.