急性缺血性卒中患者入院时血细胞比容与早期神经功能恶化的相关性

目的 探讨早期血细胞比容(hematocrit,Hct)在预测急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)中的价值.方法 前瞻性纳入发病24 h内的急性缺血性卒中患者.根据测得的Hct的四分位数分为低水平Hct、正常水平Hct和高水平Hct.END定义为住院后5 d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分或运动项目评分增加≥1分.比较END组和非END组的血管危险因素、临床特征、基线NIHSS评分、梗死灶大小和实验室检查指标.采用多变量logistic回归分析确定END的独立危险因素.结果 共纳入216例急性缺血性卒中,男性128例(59.26%),平均年龄(67.40±14.12)岁;62例(28.7%)发生END,男性和女性Hct正常范围分别为40.12%~46.35%和38.32%~44.17%.单变量分析显示,END组与非END组基线NIHSS评分(P=0.001)、空腹血糖水平(P=0.030)、C反应蛋白水平(P=0.041)以及不同Hct水平的患者构成比(P=0.023)存在显著性差异.高水平(40.0%)和低水平(35.2%)Hct患者END发生率均显著高于Hct正常患者(20.4%),但高水平与低水平Hct患者之间无显著统计学差异(P=0.690).多变量logistic回归分析显示,高水平Hct(优势比2.460,95%可信区间1.146~5.283;P=0.021)和基线NIHSS评分较高(优势比1.070,95%可信区间1.014~1.129;P=0.013)是END的独立危险因素.结论 Hct高的急性缺血性卒中患者易发生END.

Correlation between hematocrit and early neurological deterioration in patients with acute ischemic stroke on admission

Objective To investigate the value of early hematocrit (Hct) level in predicting early neurological deterioration (END) in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke within 24 h of onset were enrolled prospectively. They were divided into low Hct, normal Hct, and high Hct according to the quantile of the measured Hct. END was defined as an increase of ≥2 of the National Institute of Health Stroke Scale (NIHSS) score or ≥1 of the motor item score within 5 d after admission compared with the baseline. The vascular risk factors, clinical features, baseline NIHSS score, infarct size, and laboratory test variables were compared between the END group and the non -END group. Multivariate logistic regression analysis was used to identify the independent risk factors for END. Results A total of 216 patients with acute ischemic stroke were enrolled, including 128 males (59.26%). Their mean age was 67.40 ±14.12 years. Sixty-two patients (28.70%) experienced END. The normal ranges of Hct in male and female were 40.12%-46.35% and 38.32%-44.17%, respectively. Univariate analysis indicated that there were significantly differences in baseline NIHSS score ( P =0.001), fasting glucose (P =0.030), C reactive protein (CRP) (P =0.041), and the proportions of different Hct levels between the END group and the non-END group (P =0.023). The END incidences in patients with high -level Hct (40.0%) and low –level Hct (35.2%) were significantly higher than that in the normal Hct patients (20 .4%), but there was no significant difference between the high-level and low -level Hct patients ( P = 0.690). Multivariate logistic regression analysis showed that the igh-level Hct (odds ratio 2.460, 95% confidence interval 1.146-5.283; P =0.021) and the baseline NIHSS score (odds ratio 1.070, 95% confidence interval 1.014-1.129; P = 0.013) were the independent risk factors for END. Conclusion The elevated Hct in patients with acute ischemic stroke are susceptible to END.