摘要
目的 探讨轻型缺血性卒中患者的功能转归并明确其转归不良的危险因素.方法 前瞻性纳入发病后72 h内就诊的轻型缺血性卒中患者,根据发病后90 d时改良Rankin量表（modified Rankin Scale,mRS）评分将患者分为转归不良组（mRS评分＞2分）和转归良好组（mRS评分0～2分）.采用单变量分析和多变量logistic回归分析对人口统计学资料、血管危险因素、临床资料、实验室检查资料、影像学资料和随访资料进行比较和分析,明确轻型缺血性卒中转归不良的危险因素.结果 共纳入253例轻型缺血性卒中患者,其中71例（28.1％）转归不良.单变量分析显示,转归不良组年龄（=2.037,P=0.043）、基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分（U=4 610.000,P=0.000）、基线mRS评分（U=5 723.000,P=0.000）以及既往缺血性卒中史（x2 =4.950,P=0.026）、有症状大血管重度狭窄或闭塞（x2=49.037,P=0.000）、大动脉粥样硬化型卒中（x2=34.359,P=0.000）、早期神经功能恶化（x2=45.804,P=0.000）、并发肺炎（x2=12.121,P=0.000）以及缺血性卒中复发（x2=14.305,P=0.000）的患者比例显著性高于转归良好组.多变量logistic回归分析显示,高龄[优势比（odds ratio,OR）1.049,95％可信区间（confidence interval,CI）1.012 ～1.086;P=0.008]、基线mRS评分较高（OR 2.130,95％ CI 1.212～3.743;P=0.009）、基线NIHSS评分较高（OR 1.532,95％ CI 1.064 ～2.206;P=0.022）、有症状大血管重度狭窄或闭塞（OR 7.569,95％ CI 3.497～ 16.380;P=0.000）、早期神经功能恶化（OR 7.369,95％ CI2.648～20.510;P =0.000）和缺血性卒中复发（OR 10.450,95％ CI 3.071 ～35.564;P=0.000）是转归不良的独立危险因素.结论 超过1/4的轻型缺血性卒中患者转归不良,高龄、基线mRS评分较高、基线NIHSS评分较高、有症状大血管重度狭窄或闭塞、早期神经功能恶化以及缺血性卒中复发是其转归不良的独立危险因素.
Objective To investigate the functional outcome in patients with mild ischemic stroke and to identify its risk factors for poor outcome.Methods The patients with mild ischemic stroke treated within 72 hours after onset were enrolled prospectively.According to modified Rankin Scale （mRS） scores at day 90 after onset,the patients were randomly divided into either a poor outcome group （mRS score 〉2） or a good outcome group （mRS scores 0-2）.Univariate analysis and multivariate logistic regression analysis were used to compare and analyze the demographic data,vascular risk factors,clinical data,laboratory data,imaging data,and follow-up data.The risk factors for poor outcome in patients with mild ischemic stroke were identified.Results A total of 253 patients with mild ischemic stroke were enrolled,and 71 of them （28.1%） had poor outcome.Univariate regression analysis showed that the patients＇ proportions of age （t =2.037,P =0.043）,baseline National Institutes of Health Stroke Scale （NIHSS） score （U =4 610.000,P =0.000）,baseline mRS score （U =5 723.000,P =0.000）,as well as previous history of ischemic stroke （x2 =4.950,P =0.026）,severe symptomatic artery stenosis or occlusion （x2 =49.037,P =0.000）,large artery atherosclerotic stroke （x2 =34.359,P =0.000）,early neurologic deterioration （x2 =45.804,P =0.000）,complicated by pneumonia （x2 =12.121,P =0.000） and recurrent ischemic stroke （x2 =14.305,P =0.000） of the poor outcome group were significantly higher than those of the good outcome group.Multivariate logistic regression analysis showed that advanced age （odds ratio [OR] 1.049,95% confidence interval [CI] 1.012-1.086; P =0.008）,higher baseline mRS score （OR,2.130,95% CI 1.212-3.743;P=0.009）,higher baseline NIHSS score （OR 1.532,95% CI 1.064-2.206; P=0.022）,severe symptomatic large artery stenosis or occlusion （OR 7.569,95% CI 3.497-16.380; P=0.000）,early neurological deterioration （OR 7.369,95% CI 2.648-20.510; P =0.000） and recurrent ischemic stroke （OR 10.450,95% CI 3.071-35.564; P =0.000） were the independent risk factors for poor outcome.Conclusions More than one fourth of the patients with mild ischemic stroke had poor outcome.Advanced age,higher baseline mRS score,higher baseline NIHSS score,severe symptomatic large artery stenosis or occlusion,early neurological deterioration,and recurrent ischemic stroke were the independent risk factors for poor outcome.
出处
《国际脑血管病杂志》
北大核心
2014年第5期365-370,共6页
International Journal of Cerebrovascular Diseases
关键词
卒中
脑缺血
疾病严重程度指数
预后
危险因素
Stroke
Brain Ischemia
Severity of Illness Index
Prognosis
Risk Factors
