大脑中动脉供血区急性脑梗死患者早期神经功能恶化危险因素分析

目的探讨大脑中动脉供血区急性脑梗死患者早期神经功能恶化(END)的危险因素。方法回顾性连续纳入2009年1月至2012年12月于南京军区南京总医院神经内科住院的大脑中动脉供血区急性脑梗死并完成全脑DSA检查的患者81例。END定义为入院72 h内美国国立卫生研究院卒中量表(NIHSS)评分较入院基线评分增加≥2分或运动评分项增加≥1分。将所有患者根据是否发生END分为END组26例和非END组55例,采用单因素分析两组间临床资料的差异,侧支循环分级标准采用美国介入治疗神经放射学学会/介入放射学学会侧支循环评估系统。采用多因素Logistic回归分析大脑中动脉供血区急性脑梗死发生END的危险因素。结果与非END组比较,END组患者年龄≥60岁65.4%(17/26)比36.4%(20/55);χ~2=5.992,P=0.014]、超敏C反应蛋白水平≥4.0 mg/L76.9%(20/26)比45.5%(25/55);χ~2=7.080,P=0.008]及糖尿病患者比例38.5%(10/26)比16.4%(9/55);χ~2=4.802,P=0.028]均显著升高,而侧支循环分级显著降低(Z=-3.253,P0.01)。多因素Logistic回归分析显示,年龄≥60岁(OR=3.412,95%CI:1.075~10.824;P=0.037)、超敏C反应蛋白水平≥4.0 mg/L(OR=3.812,95%CI:1.141~12.740;P=0.030)及侧支循环分级(OR=2.165,95%CI:1.241~5.514;P=0.009)为大脑中动脉供血区急性脑梗死发生END的独立危险因素。结论大脑侧支循环分级下降和年龄≥60岁、超敏C反应蛋白水平≥4.0 mg/L是大脑中动脉供血区急性脑梗死发生END的独立危险因素。

Analysis of risk factors for early neurological deterioration in patients with acute middle cerebral artery infarction

Objective To investigate the risk factors for early neurological deterioration (END) in patients with acute middle cerebral artery infarction.Methods From January 2009 to December 2012,81 patients with acute middle cerebral artery infarction completed cerebral angiography admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.END was defined as that the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 or the motor score increased ≥ 1 with in 72 h after admission compared with the baseline score on admission.All the patients were divided into either an END group (26 cases) or a non-END group (55 cases) according to whether the occurrence of END.Univariate factor analysis was used to analyze the differences of the clinical data between the two groups.The grade standard of collateral circulation was assessment with the collateral circulation assessment system of the American Society of Interventional and Therapeutic Neuroradiology/Sociey of Interventional Radiology.Multivariable Logistic regression analysis was used to analyze the risk factors for END after acute middle cerebral artery infarction.Results Compared with the patients in the non-END group,the proportions of age 60 years (65.4％ 17/26] vs.36.4％ 20/55];x2 =5.992,P =0.014),high-sensitivity C-reactive protein level ≥4.0 mg/L (76.9％ 20/26] vs.45.5％ 25/55];x2 =7.080,P =0.008) and diabetes (38.5％ 10/26] vs.16.4％ 9/55],x2 =4.802,P =0.028) in the END group were increased significantly,while the collateral circulation grade was decreased significantly (Z =-3.253,P ＜ 0.01).Multivariable Logistic regression analysis showed that the age ≥60 years (OR,3.412,95 ％ CI 1.075-10.824;P =0.037),high-sensitivity C-reactive protein level ≥ 4.0 mg/L (OR,3.812,95％ CI 1.141-12.740;P =0.030),and collateral circulation grade (OR,2.165,95％ CI 1.241-5.514;P =0.009) were the independent risk factor for END in acute middle cerebral artery infarction.Conclusion The decreased collateral circulation level,age ≥ 60 years and high-sensitivity C-reactive protein≥4.0 mg/L were the independent risk factors for occurring END in acute middle cerebral artery infarction.