摘要
目的探讨急性脑梗死后全身炎症反应综合征（SIRS）及相关临床因素与预后的关系。方法采用前瞻性试验设计，对500例急性脑梗死患者进行SIRS及各相关因素调查，并行单因素分析和Cox回归生存分析。结果500例脑梗死患者中SIRS85例，其中完全前循环发生SIRS31例；部分前循环34例，后循环15例；腔隙性梗死5例。脑梗死患者出现发热后，不同类型脑梗死SIRS发生率与病死率有较强的一致性（Spearman1．0，P〈0．001）。单因素分析年龄、感染、48h神经功能缺损评分，48h Glassgow评分、牛津郡社区卒中计划（OCSP）、吞咽困难、糖尿病为SIRS危险因素；SIRS为脑梗死后21d病死率的危险因素。Cox回归分析显示脑梗死预后的独立危险因素为48h Glassgow评分，SIRS人选方程，但P值〉0．05。结论急性脑梗死后SIRS及其相关危险因素与脑梗死21d内病死率显著相关，糖尿病脑梗死患者SIRS发生率高。脑梗死患者出现发热后，不同OCSP分型脑梗死SIRS发生率与病死率有较强的一致性。
Objective To investigate whether systemic inflammatory response syndrome （SIRS） after cerebral infarction is associated with poor outcome and its associated clinical factors. Methods We prospectively studied 500 patients with cerebral infarction, recorded the associated clinical factors on presentation and calculated the mortality at 21st day. Results There are 85 SIRS patients in 500 patients with cerebral infarction, 31 with total anterior cerebral infarction （ TACI ）, 34 with partial anterior cerebral infarction（PACI）, 15 with posterior cerebral infarction （POCI） and 5 with lacunar cerebral infarction （LACI）. The frequency of SIRS was positively correlated with mortality rate according to Oxfordshire Commanity Stroke Project（OCSP） subtypes in cerebral infarction patients with fever （Spearman correlation coefficient = 1.0; P 〈 0. 001 ）. Single factor analysis showed that the risk factors for both SIRS and mortality of cerebral infarction were as follows ： age, infection, 48 h Chinese Stroke Scale score, 48 h Glassgow score, OCSP subtypes and dysphagia. Diabetes was the risk factor for SIRS, but had no effect on mortality. On Cox regression, 48 h Glassgow score was the sole independent risk factor of outcome. However, if SIRS was included in the formula, P 〉 0. 05. Conclusions SIRS is the predictor of poor outcome after acute cerebral infarction. It is important to prevent SIRS especially in TACI and POCI. Diabetes is the risk factor for SIRS, hut has no effect on mortality.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2008年第12期988-990,共3页
Chinese Journal of Internal Medicine
基金
上海市科学技术发展基金（044119736）
关键词
脑梗死
全身炎症反应综合征
前瞻性研究
Brain infarction
Systemic inflammatory response syndrome
Prospective studies
