急性缺血性卒中患者早期神经功能恶化的预测因素

目的 探讨急性缺血性卒中患者早期神经功能恶化(early neurologic deterioration,END)的危险因素.方法 回顾性纳入急性缺血性卒中患者,收集患者的临床资料和实验室检查结果.根据发病后7d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分变化分为END组与非END组,END定义为NIHSS评分较基线水平增加≥3分.采用多变量logistic回归分析确定急性缺血性卒中患者END的独立危险因素.结果 共纳入328例急性缺血性卒中患者,其中74例(22.6％)发生END,254例(77.4％)未发生END.END组男性、高血压、既往卒中或短暂性脑缺血发作史、脑干或小脑梗死、入院前使用抗高血压药的患者构成比以及入院前收缩压均显著高于非END组(P均＜0.05),白细胞计数、中性粒细胞百分比、低密度脂蛋白胆固醇、空腹血糖、高半胱氨酸、C反应蛋白和纤维蛋白原水平均显著高于非END组(P均＜0.05).多变量logistic回归分析显示,白细胞计数优势比(odds ratio,OR)2.126,95％可信区间(confidence interval,CI)1.240 ～4.325);P=0.028]、低密度脂蛋白胆固醇(OR 2.486,95％ CI 1.932 ～6.021;P=0.036)、高半胱氨酸(OR 2.787,95％ CI 1.194 ～6.902;P=0.036)和C反应蛋白(OR 3.416,95％ CI 1.552～10.650;P =0.032)较高是急性缺血性卒中患者发生END的独立预测因素.结论 白细胞计数、低密度脂蛋白胆固醇、高半胱氨酸和C反应蛋白较高是急性缺血性卒中患者END的独立预测因素.

Predictors of early neurologic deterioration in patients with acute ischemic stroke

Objective To investigate the risk factors for early neurologic deterioration (END) in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke were enrolled retrospectively.The clinical data and laboratory findings of the patient were collected.They were divided into an END group and a non-END group at day 7 after onset according to the changes of the National Institutes of Health Stroke Scale (NIHSS) scores.END was defined as NIHSS scores increasing ≥3 scores compared with the baseline level.Multivariate logistic regression analysis was used to determine the independent risk factors for END in patients with acute ischemic stroke.Results A total of 328 patients with acute ischemic stroke were enrolled,74 (22.6％) had END,254 (77.4％) did not have END.The proportions of male,hypertension,history of previous stroke or TIA,brainstem or cerebellar infarction,using antihypertensive drugs in patients before admission,and systolic blood pressure before admission in the END group were significantly higher than those in the non-END group (all P ＜0.05).White blood cell count,neutrophil percentage,low-density lipoprotein cholesterol,fasting blood glucose,homocysteine,Creactive protein,and fibrinogen levels were significantly higher than those in the non-END group (all P ＜ 0.05).Multivariate logistic regression analysis showed that the higher white blood cell count (odds ratio,OR] 2.126,95％ confidence interval CI] 1.240-4.325;P =0.028),low-density lipoprotein cholesterol (OR 2.486,95％ CI 1.932-6.021;P=0.036),homocysteine (OR 2.787,95％ CI 1.194-6.902;P =0.036),and C-reactive protein (OR 3.416,95％ CI 1.552-10.650;P =0.032) were the independent predictors of occurring END in patients with acute ischemic stroke.Conclusion White blood cell count,lowdensity lipoprotein cholesterol,higher homocysteine and C-reactive protein are the independent predictors of END in patients with acute ischemic stroke.