摘要
目的探讨基于牛津郡社区卒中项目(oxfordshire community stroke project,OCSP)分型的急性缺血性卒中(acute ischemic stroke,AIS)患者早期神经功能恶化(early neurological deterioration,END)的预测因素。方法回顾性纳入2018年2月至2020年11月在南京大学医学院附属鼓楼医院神经内科住院的AIS患者。根据OCSP标准进行临床分型:完全前循环梗死(total anterior circulation infarct,TACI)、部分前循环梗死(partial anterior circulation infarct,PACI)、后循环梗死(posterior circulation infarct,POCI)和腔隙性梗死(lacunar infarct,LACI)。END定义为发病72 h内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NHISS)总分较基线值增加≥2分或运动项评分增加≥1分。应用多变量logistic回归分析确定不同OCSP分型AIS患者END的独立危险因素,应用受试者工作特征(receiver operating characteristic,ROC)曲线分析各指标对不同OCSP分型AIS患者END的预测价值。结果共纳入405例AIS患者,年龄(68.84±12.27)岁,男性250例(61.7%);TACI组132例(32.6%),PACI组108例(26.7%),POCI组61例(15.1%),LACI组104例(25.7%)。136例(33.6%)发生END。多变量logistic回归分析显示,高半胱氨酸(homocysteine,Hcy)[优势比(odds ratio,OR)1.065,95%置信区间(confidence interval,CI)1.012~1.212;P=0.015]、基线NIHSS评分(OR 1.209,95%CI 1.095~1.335;P<0.001)和发病至入院时间(OR 1.663,95%CI 1.282~2.082;P<0.001)与TACI组END显著独立相关;Hcy(OR 1.137,95%CI 1.040~1.244;P=0.005)、空腹血糖(OR 1.714,95%CI 1.272~2.311;P<0.001)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)(OR 1.370,95%CI 1.016~1.848;P=0.039)和发病至入院时间(OR 1.266,95%CI 1.056~1.519;P=0.011)与PACI组END显著独立相关;NLR(OR 1.446,95%CI 1.031~2.027;P=0.033)与POCI组END显著独立相关;空腹血糖(OR 1.301,95%CI 1.006~1.683;P=0.045)、NLR(OR 1.393,95%CI 1.025~1.894;P=0.034)和发病至入院时间(OR 1.171,95%CI 1.008~1.361;P=0.039)与LACI组END显著独�
Objective To investigate the predictors of early neurological deterioration(END)in patients with acute ischemic stroke(AIS)based on the Oxfordshire Community Stroke Project(OCSP)classification system.Methods Patients with AIS admitted to the Department of Neurology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from February 2018 to November 2020 were enrolled retrospectively.According to the OCSP criteria,the patients were classified into total anterior circulation infarct(TACI),partial anterior circulation infarct(PACI),posterior circulation infarct(POCI),and lacunar infarct(LACI).END was defined as the National Institutes of Health Stroke Scale(NIHSS)total score within 72 h after onset increased by≥2 or motor function score increased by≥1 compared with the baseline.Multivariate logistic regression analysis was used to determine the independent risk factors for END in AIS patients with different OCSP types.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for END in AIS patients with different OCSP types.Results A total of 405 patients with AIS were enrolled.Their age was 68.84±12.27 years,and 250 were males(61.7%);132 patients(32.6%)were in the TACI group,108(26.7%)were in the PACI group,61(15.1%)were in the POCI group,and 104(25.7%)were in the LACI group.END occurred in 136 patients(33.6%).Multivariate logistic regression analysis showed that homocysteine(Hcy)(odds ratio[OR]1.065,95%confidence interval[CI]1.012-1.212;P=0.015),baseline NIHSS score(OR 1.209,95%CI 1.095-1.335;P<0.001)and the time from onset to admission(OR 1.663,95%CI 1.282-2.082;P<0.001)were significantly and independently correlated with END in the TACI group.Hcy(OR 1.137,95%CI 1.040-1.244;P=0.005),fasting blood glucose(OR 1.714,95%CI 1.272-2.311;P<0.001),neutrophil to lymphocyte ratio(NLR)(OR 1.370,95%CI 1.016-1.848;P=0.039)and the time from onset to admission(OR 1.266,95%CI 1.056-1.519;P=0.011)were significantly and independently correlated with E
作者
金雪红
裴少芳
徐运
张馨
Xuehong Jin;Shaofang Pei;Yun Xu;Xin Zhang(Department of Neurology,North District,Suzhou Municipal Hospital,Suzhou 215008,China;Department of Neurology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《国际脑血管病杂志》
2021年第10期725-731,共7页
International Journal of Cerebrovascular Diseases
关键词
卒中
脑缺血
疾病恶化
时间因素
危险因素
Stroke
Brain ischemia
Disease progression
Time factors
Risk factors
