缺血性小卒中转归不良的相关因素

目的：探讨缺血性小卒中患者转归不良的危险因素。方法前瞻性纳入缺血性小卒中患者，在发病后90 d时应用改良Rankin量表评估临床转归，0~2分定义为转归良好。对转归良好组与转归不良组人口统计学资料、血管危险因素、临床资料、影像学资料、卒中病因学分型、实验室化验结果、治疗方法等进行比较，采用多变量logistic回归分析确定缺血性小卒中患者早期转归不良的独立危险因素。结果共纳入516例缺血性小卒中患者。发病后90 d时90例（17.44％）转归不良，426例（82.56％）转归良好。多变量logistic回归分析显示，年龄[优势比（odds ratio, OR）1.045，95％可信区间（confidence interval, CI）1.017~1.074；P=0.002]、心脏病（OR 2.021，95％CI 1.063~3.841；P=0.032）、基线美国国立卫生研究院卒中量表（ National Institutes of Health Stroke Scale, NIHSS）评分（OR 1.662，95％CI 1.177~2.347；P=0.004）、肢体运动障碍（OR 2.430，95％CI 1.010~5.850；P=0.048）、共济运动障碍（ OR 2.929，95％CI 1.188~7.221；P=0.020）、早期神经功能恶化（OR 50.994，95％CI 17.659~147.258；P<0.001）、梗死灶直径（OR 1.279，95％CI 1.075~1.521；P=0.005）、非责任血管狭窄（ OR 2.518，95％CI 1.145~5.536；P=0.022）、大动脉粥样硬化性卒中（ OR 2.010，95％CI 1.009~4.003；P=0.047）是缺血性小卒中转归不良的独立危险因素。结论缺血性小卒中早期转归不良与年龄、心脏病史、基线NIHSS评分、肢体运动障碍、共济运动障碍、早期神经功能恶化、梗死灶直径、非责任血管狭窄、大动脉粥样硬化性卒中密切相关，需早期完善相关检查，明确病因分型，指导临床进行正确治疗。

Factors associated w ith unfavorable outcome in minor ischemic stroke

ObjectiveToinvestigatetheriskfactorsforunfavorableoutcomeinpatientswithminor ischemic stroke. Methods Patients with minor ischemic stroke were enroled prospectively. The modified Rankin Scale ( mRS ) w as used to assess the clinical outcome at day 90 after onset, and mRS 0-2 w as defined as favorable outcome. The demographic data, vascular risk factors, clinical data, imaging data, stroke etiologic subtypes, laboratory test results, and treatment methods in the favorable outcome group and unfavorable outcome group w ere compared. Multivariate logistic regression analysis w as used to identify the independent risk factors for early poor outcome in patients w ith minor ischemic stroke. Results A total of 516 patients with minor ischemic stroke were enroled. At day 90 after onset, 90 patients (17.44%) had unfavorable outcome and 426 (82.56%) had favorable outcome. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.045, 95% confidence interval [CI] 1.017-1.074; P=0.002), heart diseases (OR 2.021, 95%CI 1.063-3.841; P=0.032), baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.662, 95%CI 1.177-2.347; P=0.004), limb movement disorder ( OR 2.430, 95%CI 1.010-5.850; P=0.048), ataxia (OR 2.929, 95%CI 1.188-7.221;P=0.020), early neurological deterioration ( OR 50.994, 95%CI 17.659-147.258; P<0.001), infarct diameter ( OR 1.279, 95%CI 1.075-1.521; P=0.005), non-responsible vascular stenosis ( OR 2.518, 95%CI 1.145-5.536;P=0.022), and large artery atherosclerotic stroke ( OR 2.010, 95%CI 1.009-4.003; P=0.047) w ere the independent risk factors for unfavorable outcome in minor ischemic stroke. Conclusions The early poor outcome of minor ischemic stroke is closely associated w ith age, heart diseases, baseline NIHSS score, limb movement disorder, ataxia, early neurological deterioration, infarct diameter, non-responsible vascular stenosis, and large artery atherosclerotic stroke. The relevant examinations need to be improved early, the etiologic subtype should be identified, and the correct clinical treatment should be guided.