摘要
目的探讨应激性高血糖比率(SHR)与大动脉粥样硬化型脑梗死患者发生卒中后认知障碍(PSCI)的关系。方法选取2023年7月—2024年6月就诊于北京京煤集团总医院的1222例大动脉粥样硬化型脑梗死患者作为研究对象。收集患者的临床资料。随访6个月,根据PSCI发生情况将患者分为PSCI组和非PSCI组。采用单因素和多因素Logistic回归分析探讨大动脉粥样硬化型脑梗死患者发生PSCI的影响因素。采用Jonckheere-Terpstra检验分析SHR与大动脉粥样硬化型脑梗死患者PSCI发生率的关系。绘制ROC曲线以评价SHR对大动脉粥样硬化型脑梗死患者发生PSCI的预测价值。结果随访6个月,199例患者发生PSCI,PSCI发生率为16.28%(199/1222)。两组年龄、文化程度、有糖尿病史者占比、行静脉溶栓者占比、LDL-C、Hcy、HbA1c、空腹血糖(FBG)、SHR、出院时改良Rankin量表(mRS)评分比较,差异有统计学意义(P<0.05)。单因素Logistic回归分析结果显示,年龄、文化程度、糖尿病史、脑卒中家族史、静脉溶栓、LDL-C、Hcy、Scr、SHR、出院时mRS评分可能是大动脉粥样硬化型脑梗死患者发生PSCI的影响因素(P<0.05)。多因素Logistic回归分析结果显示,年龄增加、文盲、有糖尿病史、LDL-C升高、Hcy升高、SHR升高是大动脉粥样硬化型脑梗死患者发生PSCI的独立危险因素,行静脉溶栓是其保护因素(P<0.05)。患者的SHR三分位数分别为0.764、0.905、0.906。大动脉粥样硬化型脑梗死伴SHR≤0.764、0.765~0.905、>0.905者的PSCI发生率分别为7.84%(32/408)、10.05%(41/408)、31.03%(126/406)。Jonckheere-Terpstra检验结果显示,大动脉粥样硬化型脑梗死患者PSCI发生率随着SHR升高而升高(Z=8.948,P趋势<0.001)。ROC曲线分析结果显示,SHR预测大动脉粥样硬化型脑梗死患者发生PSCI的AUC为0.710[95%CI(0.671~0.750)]。结论SHR升高是大动脉粥样硬化型脑梗死患者发生PSCI的独立危险因素,且其对大动脉粥样硬化型脑梗死患者发生PSCI有一定预测价值。
Objective To explore the relationship between stress hyperglycemia ratio(SHR)and post-stroke cognitive impairment(PSCI)in patients with large artery atherosclerotic cerebral infarction.Methods A total of 1222 cases of patients with large artery atherosclerotic cerebral infarction who visited Beijing Jingmei Group General Hospital from July 2023 and June 2024 were selected as study objects.The clinical data of the patients were collected.Followed-up for 6 months,patients were divided into PSCI group and non-PSCI group according to the occurrence of PSCI.Univariate and multivariate Logistic regression analysis were used to identify the influencing factors of PSCI in patients with large artery atherosclerotic cerebral infarction.Jonckheere-Terpstra test was used to show the changes of the incidence of PSCI in patients with large artery atherosclerotic cerebral infarction with different SHR.ROC curve was constructed to evaluate the predictive value of SHR for the occurrence of PSCI in patients with large artery atherosclerotic cerebral infarction.Results After 6-month follow-up,PSCI occurred in 199 cases,and the incidence of PSCI was 16.28%(199/1222).There were significant differences of age,educational level,proportion of patients with history of diabetes,proportion of patients receiving intravenous thrombolysis,LDL-C,Hcy,HbA1c,fasting blood glucose(FBG),SHR,modified Rankin Scale(mRS)score at discharge between the two groups(P<0.05).Univariate Logistic regression analysis results showed that,age,educational level,history of diabetes,family history of stroke,intravenous thrombolysis,LDL-C,Hcy,serum creatinine(Scr),SHR,MRS score at discharge may be the influencing factors of PSCI in patients with large artery atherosclerotic cerebral infarction(P<0.05).Multivariate Logistic regression analysis results showed that,increased age,illiteracy,history of diabetes and elevated LDL-C,Hcy,SHR were influencing factors of PSCI in patients with large artery atherosclerotic cerebral infarction,and intravenous thrombolysis was its protective factor(P<0.05).The tri-sectional quantile of the patients'SHR was 0.764,0.905,and 0.906,respectively.Incidence of PSCI in large artery atherosclerotic cerebral infarction patients with SHR≤0.764,0.765-0.905,>0.905 was 7.84%(32/408),10.05%(41/408),31.03%(126/406),respectively.The Jonckheere-Terpstra test result showed that the incidence of PSCI in patients with large artery atherosclerotic cerebral infarction increased with the increase of SHR(Z=8.948,P for trend<0.001).ROC curve analysis showed that the AUC of SHR in predicting PSCI in patients with large artery atherosclerotic cerebral infarction was 0.710[95%CI(0.671-0.750)].Conclusion Elevated SHR is an independent risk factor for PSCI in patients with large artery atherosclerotic cerebral infarction,and it can facilitate the onset and progression of PSCI and has a certain predictive value.
作者
王鹤
殷煜
牛利
张明建
连航钺
张丽霞
安娜
WANG He;YIN Yu;NIU Li;ZHANG Mingjian;LIAN Hangyue;ZHANG Lixia;AN Na(General Practice Department,Beijing Jingmei Group General Hospital,Beijing 102399,China)
出处
《实用心脑肺血管病杂志》
2025年第8期57-63,共7页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
北京京煤集团总医院2024年第四季度院级科研自主项目(ZZ2024-45)。
关键词
脑梗死
卒中后认知障碍
应激性高血糖比率
影响因素分析
Brain infarction
Post-stroke cognitive impairment
Stress hyperglycemia ratio
Root cause analysis
