急性缺血性脑卒中患者中国缺血性卒中亚型分型与早期神经功能恶化的关系

目的探讨中国缺血性卒中亚型(Chinese ischemic stroke subclassification,CISS)分型与早期神经功能恶化(END)的关系。方法连续收集2017年6月~2018年12月常州市第二人民医院神经内科住院的老年急性缺血性脑卒中患者157例,按照CISS分型标准分为大动脉粥样硬化型78例,心源性脑卒中16例,穿支动脉疾病63例。根据END定义分为END组86例,非END组71例,比较2组一般临床指标。所有患者采用美国国立卫生研究院卒中量表(NIHSS)评分评估神经功能缺损程度,END定义为入院后72h内NIHSS评分较基线增加≥2分。采用多因素logistic回归分析END的危险因素。结果与非END组比较,END组入院NIHSS评分明显高于非END组(4.7±2.9)分vs (3.0±2.2)分,P=0.000]。2组CISS分型比较,差异有统计学意义(P=0.014)。多因素logistic回归分析显示,入院NIHSS评分(OR=0.729,95%CI:0.621~0.857,P=0.000)、穿支动脉疾病(OR=3.399,95%CI:1.603~7.208,P=0.001)是END的独立危险因素。结论入院NIHSS评分、穿支动脉疾病是急性缺血性脑卒中患者END的独立危险因素。

Relationship between Chinese ischemic stroke subclassification and early neurological deterioration in acute ischemic stroke patients

Objective To study the relationship between Chinese ischemic stroke subclassification(CISS)and early neurological deterioration(END)in acute ischemic stroke(AIS)patients.Methods One hundred and fifty-seven AIS patients were divided into large artery athroslerosis group(n=78),cardiogenic stroke group(n=16)and perforating artery disease(PAD)group(n=63)according to the CISS and further divided into END group(n=86)and non-END group(n=71)according to the END definition.The general clinical data were compared between END and nonEND groups.The neurological deterioration was scored according to the NIHSS.The END was defined as the NIHSS score≥2-fold within 72 hafter admission than the baseline score.The risk factors for END were analyzed by multivariate logistic regression analysis.Results The NIHSS score was significantly higher in END group than in non-END group(4.7±2.9 vs 3.0±2.2,P=0.000).A significant difference was detected in CISS between the two groups(P=0.014).Multivariate logistic regression analysis showed that the NIHSS score on admission and PAD were the independent risk factors for END in AIS patients(OR=0.729,95%CI:0.621-0.857,P=0.000;OR=3.399,95%CI:1.603-7.208,P=0.001).Conclusion NIHSS score on admission and PAD are the independent risk factors for END in AIS patients.