青年缺血性卒中患者早期不良结局的相关因素分析

发布时间：2018-04-09 09:22

  本文选题：缺血性卒中　切入点：结局　出处：《中国脑血管病杂志》2017年08期

【摘要】：目的探讨青年缺血性卒中患者早期不良结局的相关因素。方法回顾性连续纳入2006年1月至2016年6月南京军区南京总医院神经内科住院的青年急性缺血性卒中(18~45岁)患者685例,均经头部CT或MRI确诊为首次发病。根据患者出院90 d随访时改良Rankin量表(mRS),将其分为结局良好(mRS 0~2分)组(554例)和结局不良(mRS 3~6分)组(131例)。入院当天完善临床资料的收集,包括脑血管病危险因素(口服避孕药等)、入院时美国国立卫生研究院卒中量表(NIHSS)评分、住院后前3 d平均收缩压(以140 mmHg进行分析)及实验室检查等。卒中亚型采用急性卒中低分子肝素试验(TOAST)分型标准。采用单因素分析组间临床资料的差异,并对早期不良结局的危险因素进行多因素Logistic回归分析。结果与结局良好组比较,结局不良组住院后前3 d平均收缩压140 mmHg者的比率[37.4%(49/131)比21.7%(120/554),χ~2=14.131]、入院时NIHSS评分[10.0(7.0,14.0)分比1.5(0,3.0)分,Z=-15.300]、白细胞计数[7.5(6.0,9.0)×10~9/L比6.8(5.7,8.2)×10~9/L,Z=-3.157]、空腹血糖[4.9(4.6,6.0)mmol/L比4.8(4.4,5.3)mmol/L,Z=-2.726]、纤维蛋白原水平[2.8(2.3,3.4)g/L比2.6(2.3,3.2)g/L,Z=-2.018]较高,血尿酸[291(220,346)mmol/L比315(261,374)mmol/L,Z=-3.443]和血浆白蛋白水平[43.1(40.0,45.9)g/L比44.8(42.4,47.4)g/L,Z=-4.708]降低,组间差异均有统计学意义(均P0.05)。TOAST分型比较,结局不良组心源性栓塞患者比例高于结局良好组,组间差异有统计学意义[6.9%(9/131)比2.5%(14/554),χ~2=4.893,P0.05]。其余临床资料的组间差异均无统计学意义(均P0.05)。多因素Logistic回归分析结果显示,入院时NIHSS评分较高(OR=1.474,95%CI:1.378~1.576,P0.01)、入院后前3 d平均收缩压140 mmHg(OR=2.134,95%CI:1.210~3.764,P=0.009)、心源性栓塞(OR=4.902,95%CI:1.073~22.222,P=0.040)是早期不良结局的危险因素,而血浆白蛋白水平升高(OR=0.902,95%CI:0.850~0.956,P=0.001)是早期良好结局的保护因素。结论入院时NIHSS评分较高、心源性栓塞和入院后前3 d平均收缩压升高可能是青年缺血性卒中患者早期结局不良的独立危险因素,而血浆白蛋白水平升高有利于其早期结局。
[Abstract]:Objective to explore the related factors of early adverse outcome in young patients with ischemic stroke.Methods from January 2006 to June 2016, a total of 685 young patients with acute ischemic stroke (1845 years old) admitted to the Department of Neurology, Nanjing General Hospital of Nanjing military region from 2006 to June 2016, were all diagnosed as the first onset by CT or MRI.According to the modified Rankin scale for 90 days after discharge, the patients were divided into two groups: 554 patients with good outcome (0 ~ 2)) and 131 patients with poor outcome (3 ~ 6).On the day of admission, we completed the collection of clinical data, including the risk factors of cerebrovascular disease (oral contraceptive pills, etc.), and the NIHSS score of the National Institutes of Health Stroke scale at admission.The mean systolic blood pressure (analysed by 140 mmHg) and laboratory examination in the first 3 days after hospitalization.The subtype of stroke was classified by acute stroke low molecular weight heparin test (TOAST).Single factor analysis was used to analyze the difference of clinical data and multivariate Logistic regression analysis was used to analyze the risk factors of early adverse outcome.缁撴灉涓庣粨灞，

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