急性脑梗死患者1年预后不良的相关危险因素分析

目的 探讨任丘地区急性脑梗死患者1年预后不良的相关危险因素。方法 收集2014年1月20日至2017年12月30日连续入院并符合入组标准的急性脑梗死患者3 252例，按患者发病1年随访时临床结局改良Rankin量表评分(modified Rankin scale, mRs)进行分组，预后良好组（mRs评分≤2分）2 912例，预后不良组（mRs评分＞2分）340例，分析急性脑梗死患者1年预后不良的相关危险因素。结果 急性脑梗死预后不良组年龄、糖尿病史、高脂血症史、脑卒中史、心房颤动史、冠心病史、吸烟、饮酒、颈动脉斑块形成、抗血小板聚集药物使用、文化程度、收缩压、空腹血糖、甘油三酯、高密度脂蛋白胆固醇、脂蛋白a、肌酐、胱抑素C、凝血酶原时间、国际标准化比值、纤维蛋白原、同型半胱氨酸、入院24 h内NIHSS评分与预后良好组比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析，显示年龄、脑卒中史、收缩压、肌酐、纤维蛋白原、入院24 h内NIHSS评分为急性脑梗死患者1年预后不良的独立危险因素。结论 急性脑梗死患者发病时年龄、脑卒中史、收缩压、肌酐、纤维蛋白原、入院24 h内NIHSS评分是发病1年时预后不良的独立危险因素，早期识别及关注预后不良人群，采取积极预防，可降低不良预后的风险。

Risk factors for one year poor prognosis in acute cerebral infarction patients

Objective To study the risk factors for one year poor prognosis in patients with acute cerebral infarction (ACI). Methods From January 20, 2014 to December 30, 2017, 3 252 ACI patients who were admitted to hospital continuously and met the inclusion criteria were selected. They were divided into good prognosis group (mRs score≤2), poor prognosis group (mRs score > 2) according to the modified Rankin scale (mRs) of one year follow up. The former involved 2 912 patients, and the latter included 340 patients. The risk factors related to one year poor prognosis of ACI patients were analyzed. Results There were statistically significant differences between poor prognosis group and good prognosis group in terms of age, history of diabetes, hyperlipidemia, stroke, atrial fibrillation, coronary heart disease, smoking, drinking, carotid artery plaque formation and antiplatelet drug use, education degree, systolic blood pressure, fasting glucose, triglycerides, high density lipoprotein cholesterol, lipoprotein a, creatinine, cystatin C, prothrombin time, international standardization rate, fibrinogen, homocysteine and NIHSS score within 24hours of admission (P<0.05). Multivariate Logistic regression analysis showed that the independent risk factors for one year poor prognosis in ACI patients were age, previous stroke, systolic blood pressure, creatinine, fibrinogen, and NIHSS score within 24 hours of admission. Conclusion The independent risk factors for one year poor prognosis in ACI patients included age of onset, previous stroke, systolic blood pressure, creatinine, fibrinogen, and NIHSS score within 24 hours of admission. Early identification and attention to the population with poor prognosis and active prevention can reduce the risk of poor prognosis.