摘要
目的分析静脉溶栓治疗首发急性缺血性脑卒中(Acute ischemic stroke,AIS)患者的预后影响因素及预测价值。方法选择2019年4月-2022年4月在溧阳市人民医院神经内科进行静脉溶栓治疗的首发AIS患者120例,根据改良Rankin量表(Modified rankin scale,mRS)分为预后良好组(n=61,<2分)和预后不良组(n=59,≥2分)。比较两组临床资料,从中筛选出首发AIS患者应用静脉溶栓治疗的预后危险因素,评估其对首发AIS患者应用静脉溶栓治疗的预测价值。结果预后不良组既往存在糖尿病史、大动脉粥样硬化分型占比大于预后良好组,发病至溶栓开始时间滞后于预后良好组,入院时美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分及血糖、纤维蛋白原水平高于预后良好组(P<0.05)。多因素Logistic回归分析发现,存在糖尿病史、发病至溶栓开始时间长、入院时NIHSS评分高、大动脉粥样硬化分型、高血糖、高纤维蛋白原为首发AIS患者应用静脉溶栓治疗后预后不良的独立危险因素(OR=4.627、4.831、5.124、5.043、4.669、4.821,P<0.05)。首发AIS患者应用静脉溶栓治疗后预后不良的曲线下面积(Area under curve,AUC)为0.812(95%CI:0.753~0.834),敏感度为0.67,特异度为0.86。结论既往存在糖尿病史、发病至溶栓开始时间长、入院时NIHSS评分高、大动脉粥样硬化分型、高血糖、高纤维蛋白原对预测首发AIS患者具有较高的敏感性和特异性。
Objective To analyze the prognostic factors and predictive value of intravenous thrombolysis for first-episode acute ischemic stroke(AIS)patients.Methods 120 first-time AIS patients who underwent intravenous thrombolysis treatment in the hospital from April 2019 to April 2022 were selected.According to the modified Rankin scale(mRS),thepatients were divided into good prognosis group(n=61,<2 points)and a poor prognosis group(n=59,≥2 points).Compare 2 sets of clinical data to identify risk factors for poor prognosis in first-episode AIS patients after intravenous thrombolysis treatment,and evaluate their predictive value for AIS patients after intravenous thrombolysis treatment.Results The poor prognosis group had a history of diabetes and a larger proportion of major atherosclerosis types than the good prognosis group,and the time from onset to the beginning of thrombolysis lagged behind the good prognosis group.At admission,National Institute of Health Stroke Scale(NIHSS)score andblood glucose and fibrinogen levels were higher than the good prognosis group(P<0.05).Multivariate logistic regression analysis found that the history of diabetes,the long time from onset to the beginning of thrombolysis,the high NIHSS score at admission,the classification of large atherosclerosis,hyperglycemia and hyperfibrinogen were the risk factors for poor prognosis of the first AIS patients after intravenous thrombolysis(OR=4.627,4.831,5.124,5.043,4.669,4.821,P<0.05).The area under curve(AUC)for predicting poor prognosis in first-episode AIS patients after intravenous thrombolysis treatment was 0.812(95%CI:0.753-0.834),with a sensitivity of 0.67and a specificity of 0.86.Conclusion The history of diabetes,the long time from onset to the beginning of thrombolysis,the high NIHSS score at admission,the classification of large atherosclerosis,hyperglycemia and hyperfibrinogen are independent risk factors which have high sensitivity and specificity in predicting first episode AIS patients.
作者
缪莲莲
黄红伟
陈硕
MIAO Lianlian;HUANG Hongwei;CHEN Shuo(Department of Neurology,People's Hospital of Liyang City,Liyang Jiangsu 213300,China;Department of Neurology,Nanjing Tongren Hospital,Nanjing 211102,China)
出处
《新疆医科大学学报》
CAS
2024年第1期68-72,共5页
Journal of Xinjiang Medical University
基金
江苏省自然科学基金面上项目(BK20201234)。
关键词
首发
急性缺血性脑卒中
静脉溶栓
预后
影响因素
first round
acute ischemic stroke(AIS)
intravenous thrombolysis
prognosis
influencing factors
