缺血性卒中血清叶酸水平与早期神经功能恶化的相关性研究

目的 探讨缺血性卒中患者基线血清叶酸水平与早期神经功能恶化（early neurological deterioration，END）的关系。方法 回顾性分析2018年1月1日-9月30日于北京市海淀医院（北京大学第三医院海淀院区）神经内科住院的发病48 h内的缺血性卒中患者的临床资料。根据是否在入院7 d内发生END，将患者分为END组和非END组，对比分析两组患者的基线资料。采用单因素和多因素逻辑回归分析缺血性卒中患者END的独立影响因素。结果 本研究共纳入304例患者，男性209例（68.8%），平均年龄67.2±13.9岁，血清叶酸水平为15.4（11.3～21.9）nmol/L。其中END组患者42例（13.8%），非END组患者262例（86.2%）。与非END组相比，END组患者具有更高的年龄（P =0.008）、糖尿病史（P =0.002）、基线NIHSS评分（P =0.022）和更低的基线叶酸水平（P =0.030），差异具有统计学意义。回归分析结果显示，年龄（每增长1岁：OR 1.033，95%CI 1.001～1.066，P =0.041）和糖尿病史（OR 2.724，95%CI 1.339～5.539，P =0.006）是END的独立危险因素；基线较高的血清叶酸水平（OR 0.463，95%CI 0.225～0.952，P =0.036）是END的独立保护因素。结论 年龄增加和糖尿病史是END的独立危险因素，基线较高的血清叶酸水平是END的独立保护因素。

Correlation between Serum Folate Level and Early Neurological Deterioration in Ischemic Stroke

Objective To explore the association between the level of serum folate and early neurological
deterioration (END) in ischemic stroke patients.
Methods Clinical data of ischemic stroke patients within 48 hours from onset who admitted
to Beijing Haidian Hospital from January 1, 2018 to September 30, 2018 were retrospectively
analyzed. According to whether END occurred within 7 days or not, all the patients were divided
into END group and non-END group. Univariate and multivariate binary logistic analysis was
performed to analyze the relationship between serum folate level and END.
Results A total of 304 patients were enrolled, with an average age of 67.2±13.9 years old and 209
males (68.8%). The average level of baseline serum folate was 15.4 (11.3-21.9) nmol/L. Of all patients,
42 (13.8%) patients worsened during the 7 days after admission. Compared with non-END group,
END group had higher age and baseline NIHSS score, higher percentage of diabetes and lower level
of folate (all P <0.05). Logistic analysis showed that age (increase per 1 year: OR 1.033, 95%CI 1.001-
1.066, P =0.041) and history of diabetes (OR 2.724, 95%CI 1.339-5.539, P =0.006) were independent
risk factors for END, and high level of serum folate (OR 0.463, 95%CI 0.225-0.952, P =0.036) was an
independent protective factor for END.Conclusions Advanced age and history of diabetes were independent risk factors for END. High
serum folate level was independent protective factor for END in ischemic stroke patients.