CAJ | 학술논문

目的：分析缺血性卒中急性期血管再通治疗后有临床意义再通（CMR）的影响因素。方法回顾性连续纳入2011年3月至2015年3月就诊于首都医科大学宣武医院神经内科并接受急性期静脉溶栓或动脉内治疗的缺血性卒中患者267例。以CMR为主要终点事件，根据是否有CMR，将患者分为有CMR组（92例）和无CMR组（175例）。采用秩和检验及Pearsonχ2检验比较两组间患者的基线资料，建立多因素Logistic回归模型分析CMR的独立影响因素。结果267例患者的中位数（四分位间距）年龄为60（51，69）岁，女性69例（25.8％），中位数（四分位间距）发病至治疗时间为250（195，305）min，中位数（四分位间距）美国国立卫生研究院卒中量表（NIHSS）评分为10（6，15）分。有CMR组患者的基线NIHSS评分、体质量指数、血糖水平和糖尿病史患者比例均明显低于无CMR组（均P≤0.05）。多因素Logistic回归分析结果显示，基线NIHSS（OR＝0.93，95％CI：0.88～0.98；P＝0.01）、静脉溶栓（相对于动脉内治疗，OR＝0.35，95％CI：0.17～0.73；P＝0.01）和基线血糖（OR＝0.87，95％CI：0.77～0.97；P ＝0.02）是CMR的独立负性预测因素。结论基线NIHSS评分、静脉溶栓（相对于动脉内治疗）和高血糖是缺血性卒中急性期再通治疗实现CMR的负性影响因素，提示急性期的血糖干预及进行动脉内治疗有助于改善临床预后。
목적：분석결혈성졸중급성기혈관재통치료후유림상의의재통（CMR）적영향인소。방법회고성련속납입2011년3월지2015년3월취진우수도의과대학선무의원신경내과병접수급성기정맥용전혹동맥내치료적결혈성졸중환자267례。이CMR위주요종점사건，근거시부유CMR，장환자분위유CMR조（92례）화무CMR조（175례）。채용질화검험급Pearsonχ2검험비교량조간환자적기선자료，건립다인소Logistic회귀모형분석CMR적독립영향인소。결과267례환자적중위수（사분위간거）년령위60（51，69）세，녀성69례（25.8％），중위수（사분위간거）발병지치료시간위250（195，305）min，중위수（사분위간거）미국국립위생연구원졸중량표（NIHSS）평분위10（6，15）분。유CMR조환자적기선NIHSS평분、체질량지수、혈당수평화당뇨병사환자비례균명현저우무CMR조（균P≤0.05）。다인소Logistic회귀분석결과현시，기선NIHSS（OR＝0.93，95％CI：0.88～0.98；P＝0.01）、정맥용전（상대우동맥내치료，OR＝0.35，95％CI：0.17～0.73；P＝0.01）화기선혈당（OR＝0.87，95％CI：0.77～0.97；P ＝0.02）시CMR적독립부성예측인소。결론기선NIHSS평분、정맥용전（상대우동맥내치료）화고혈당시결혈성졸중급성기재통치료실현CMR적부성영향인소，제시급성기적혈당간예급진행동맥내치료유조우개선림상예후。
Objective To analyze the influencing factors of having clinical meaningful recanalization (CMR)after revascularization therapy in acute phase of ischemic stroke. Methods A total of 267 consecutive patients with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital, Capital Medical University and received intravenous thrombolysis or endovascular intervention in acute stage from March 2011 and March 2015 were enrolled retrospectively. CMR was used as a primary endpoint event. They were divided into either a CMR group (n = 92)or a non-CMR group (n = 175)according to whether they had CMR. The baseline data of the patients in both groups were compared by using the Rank sum test and Pearson Chi-Square test. A multivariate logistic regression model was established to analyze the independent influencing factor of CMR. Results The median (interquartile range)age of 267 patents was 60 (51 -69)years,and 69 of them were females (25. 8%);the median (interquartile range)time from onset to treatment was 250 (195 -305)min,and the median (interquartile range)NIHSS score was 10 (6 -15). The baseline NIHSS score,body mass index,blood glucose level,and proportion of diabetes of the CMR group were significantly lower than those of the non-CMR group (all P≤0. 05). The results of multivariate logistic regression analysis showed that the baseline NIHSS (OR,0. 93,95% CI 0. 88 -0. 98;P = 0. 01),intravenous thrombolysis (with respect to endovascular intervention)(OR,0. 35, 95% CI 0. 17 -0. 73;P = 0. 01),and baseline blood glucose (OR,0. 87;95% CI 0. 77 -0. 98;P =0. 02)were the independent negative predictors of CMR. Conclusion The baseline NIHSS,intravenous thrombolysis (with respect to endovascular intervention),and high blood glucose are the negative influencing factors for achieving CMR in the acute phase of ischemic stroke,suggesting blood sugar intervention and endovascular intervention in acute phase may contribute to the improvement of clinical prognosis.