中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
8期
558-561
,共4页
李慎军%郭洪伟%王树才%曹秉振
李慎軍%郭洪偉%王樹纔%曹秉振
리신군%곽홍위%왕수재%조병진
共病现象%脑梗死%预后
共病現象%腦梗死%預後
공병현상%뇌경사%예후
Comorbidity%Brain infarction%Prognosis
目的 探讨急性脑梗死患者发病前共存病与长期预后的关系.方法 前瞻性收集2010年8月至2012年11月在济南军区总医院神经内科住院的急性脑梗死患者644例,记录其年龄、性别、Charlson共存病指数(Charlson Comorbidity Index,CCI)、美国国立卫生研究院卒中量表(NIHSS)评分等基线资料.在发病后第90天通过电话随访,采用改良Rankin量表(mRS)对其预后进行评价(mRS评分≤2分为预后良好,mRS评分＞2分为预后较差).由于CCI包含特异性共存病,所以将CCI、去除特异性共存病的CCI、特异性共存病等分别作为影响患者3个月预后的危险因素,单因素分析并筛选影响患者3个月预后的危险因素后,再采用多元Logistic回归模型分析CCI、特异性共存病是否为患者mRS评分的独立预测因子.结果 CCI(0R=3.446,95％ CI1.662～7.417;P=0.001)是评价急性脑梗死患者预后的独立预测因子.同时,心力衰竭(OR=6.229,95％ CI1.705 ～ 22.755;P =0.006)、糖尿病(OR=2.584,95％ CI1.709 ～ 3.906;P=0.000)等特异性共存病也是评价患者预后的独立预测因子.结论 发病前CCI得分越高、伴有糖尿病或心力衰竭的急性脑梗死患者预后差的可能性越大.CCI及急性脑梗死患者的特异性共存病如糖尿病、心力衰竭可作为评价患者3个月预后的敏感指标.
目的 探討急性腦梗死患者髮病前共存病與長期預後的關繫.方法 前瞻性收集2010年8月至2012年11月在濟南軍區總醫院神經內科住院的急性腦梗死患者644例,記錄其年齡、性彆、Charlson共存病指數(Charlson Comorbidity Index,CCI)、美國國立衛生研究院卒中量錶(NIHSS)評分等基線資料.在髮病後第90天通過電話隨訪,採用改良Rankin量錶(mRS)對其預後進行評價(mRS評分≤2分為預後良好,mRS評分＞2分為預後較差).由于CCI包含特異性共存病,所以將CCI、去除特異性共存病的CCI、特異性共存病等分彆作為影響患者3箇月預後的危險因素,單因素分析併篩選影響患者3箇月預後的危險因素後,再採用多元Logistic迴歸模型分析CCI、特異性共存病是否為患者mRS評分的獨立預測因子.結果 CCI(0R=3.446,95％ CI1.662～7.417;P=0.001)是評價急性腦梗死患者預後的獨立預測因子.同時,心力衰竭(OR=6.229,95％ CI1.705 ～ 22.755;P =0.006)、糖尿病(OR=2.584,95％ CI1.709 ～ 3.906;P=0.000)等特異性共存病也是評價患者預後的獨立預測因子.結論 髮病前CCI得分越高、伴有糖尿病或心力衰竭的急性腦梗死患者預後差的可能性越大.CCI及急性腦梗死患者的特異性共存病如糖尿病、心力衰竭可作為評價患者3箇月預後的敏感指標.
목적 탐토급성뇌경사환자발병전공존병여장기예후적관계.방법 전첨성수집2010년8월지2012년11월재제남군구총의원신경내과주원적급성뇌경사환자644례,기록기년령、성별、Charlson공존병지수(Charlson Comorbidity Index,CCI)、미국국립위생연구원졸중량표(NIHSS)평분등기선자료.재발병후제90천통과전화수방,채용개량Rankin량표(mRS)대기예후진행평개(mRS평분≤2분위예후량호,mRS평분＞2분위예후교차).유우CCI포함특이성공존병,소이장CCI、거제특이성공존병적CCI、특이성공존병등분별작위영향환자3개월예후적위험인소,단인소분석병사선영향환자3개월예후적위험인소후,재채용다원Logistic회귀모형분석CCI、특이성공존병시부위환자mRS평분적독립예측인자.결과 CCI(0R=3.446,95％ CI1.662～7.417;P=0.001)시평개급성뇌경사환자예후적독립예측인자.동시,심력쇠갈(OR=6.229,95％ CI1.705 ～ 22.755;P =0.006)、당뇨병(OR=2.584,95％ CI1.709 ～ 3.906;P=0.000)등특이성공존병야시평개환자예후적독립예측인자.결론 발병전CCI득분월고、반유당뇨병혹심력쇠갈적급성뇌경사환자예후차적가능성월대.CCI급급성뇌경사환자적특이성공존병여당뇨병、심력쇠갈가작위평개환자3개월예후적민감지표.
Objective To investigate the correlation between prestroke comorbidity and long-term outcomes in patients with acute cerebral infarction.Methods Consecutive acute ischemic stroke patients who were hospitalized were prospectively recruited from August 2010 to November 2012.Six hundred and forty-four patients were enrolled,the baseline data including Charlson Comorbidity Index (CCI),National Institute of Health Stroke Scale (NIHSS) score,type of Oxfordshire Community Stroke Project (OCSP:total anterior circulation infarct,partial anterior circulation infarct,posterior circulation infarct and lacunar infarct) were recorded.And recovery was assessed by modified Rankin Scale (mRS) 90 days after stroke by telephone interview (mRS score ≤ 2 reflected good prognosis,and mRS score ＞ 2 reflected unfavorable prognosis).Because CCI included specific comorbidity,we considered CCI,CCI without specific comorbidity and specific comorbidity as variable respectively.After screening the risk factors affecting prognosis using univariate analysis,the relationship between comorbidity and prognosis was estimated using multinomial logistic regression model.Results CCI was an independent predictor of good prognosis and unfavorable prognosis (OR =3.446,95％ CI 1.662-7.417; P =0.001).Congestive heart failure and diabetes were each independent predictor of good prognosis and unfavorable prognosis also (diabetes:OR =2.584,95％ CI 1.709-3.906,P =0.000; congestive heart failure:OR =6.229,95％ CI 1.705-22.755,P =0.006).Conclusions After acute ischemic stroke,the patients with the higher CCI score,diabetes and congestive heart failure are more likely to achieve unfavorable outcome.CCI,diabetes and congestive heart failure can each be used as a sensitive index to evaluate the 90 d prognosis of patients.Trial registration Clinical Research Center of China (CHiCTR-OCH-14004228)
