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目的研究进展性缺血性卒中的预测指标,为早期识别及治疗进展性卒中提供科学依据。方法连续收集2013年1月至2015年3月北京航天总医院神经内科收治的202例急性缺血性卒中患者的临床资料,并进行回顾性分析。根据美国国立卫生院脑卒中量表(NIHSS评分)将202例患者分为进展性卒中115例(PIS组)和非进展性卒中87例(NPIS组)。观察两组患者一般情况、既往史、入院后24 h内的检验结果、超声影像学及并发症等指标,采用SPSS 17.0软件进行t检验和χ~2检验,对差异有统计学意义的指标进行多因素logistic回归分析,筛选进展性卒中的危险因素。对比两组患者在不同脑梗死分型中进展性卒中的发病率。结果 PIS组高血压史、糖尿病史、高脂血症史、并发感染、消化道出血、发热、急性肾功能不全、治疗后低血压、脑梗死后出血、颈动脉狭窄及不稳定斑块等发生率高于NPIS组,差异均有统计学意义(P<0.05,P<0.01);PIS组患者糖化血红蛋白(Hb Al C)、空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、脑利钠肽(BNP)、纤维蛋白原(FI)、D-二聚体(D-D)及平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)等均明显高于NPIS组,差异均有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析结果显示,糖尿病(OR=7.011,95%CI:2.313~21.253)、颈动脉狭窄率(OR=1.029,95%CI:1.002~1.058)、脑梗死病灶的最大直径(OR=1.728,95%CI:1.048~2.850)、MAP(OR=1.030,95%CI:1.002~1.060)、FPG(OR=1.360,95%CI:1.011~1.829)、TC(OR=1.803,95%CI:1.217~2.673)、FI(OR=2.490,95%CI:1.437~4.315)、D-D(OR=1.002,95%CI:1.000~1.004)、hs-CRP(OR=1.118,95%CI:1.017~1.206)和BNP(OR=1.001,95%CI:1.000~1.002)是影响进展性卒中的高危因素,差异均有统计学意义(P<0.05,P<0.01)。在进展性卒中组中完全性前循环梗死(46.95%)及大血管硬化闭塞(51.30%)发生率最高。结论糖尿病、颈动脉狭窄、梗死最大直径及MAP、FPG、TC、FI、D-D、hs-CRP、BNP水平的升高是进展性卒中的独立危险因素,是预测进展性卒中的敏感指标。大面积前循环脑梗死也是预示卒中患者病情进展的重要因素之一。
Objective To study the prognostic indicators of progressive ischemic stroke and provide a scientific basis for early identification and treatment of advanced stroke. Methods The clinical data of 202 acute ischemic stroke patients admitted to Department of Neurology, Beijing Aerospace General Hospital from January 2013 to March 2015 were collected continuously and retrospectively analyzed. According to the National Institutes of Health Stroke Scale (NIHSS score), 202 patients were divided into progressive stroke in 115 patients (PIS group) and non-progressing stroke in 87 patients (NPIS group). The general conditions, past history, test results within 24 h after admission, ultrasound imaging and complication were observed. T test and Chi-square test were performed using SPSS 17.0 software, and the differences were statistically significant Multivariate logistic regression analysis was used to screen the risk factors of stroke. The incidence of progressive stroke was compared between the two groups in different types of cerebral infarction. Results The history of hypertension, history of diabetes, history of hyperlipidemia, complicated infection, gastrointestinal bleeding, fever, acute renal insufficiency, hypotension after treatment, hemorrhage after cerebral infarction, carotid artery stenosis and unstable plaque occurred in PIS group (P <0.05, P <0.01). HbAc, FPG, TC, LDL-C of patients in PIS group were significantly higher than those in NPIS group LDL-C, hs-CRP, BNP, DD, D-MAP and systolic pressure (SBP) and diastolic blood pressure (DBP) were significantly higher than those in NPIS group (P <0.05, P <0.01). Multivariate logistic regression analysis showed that the maximum diameter of infarction (OR = 7.011, 95% CI: 2.313-21.253), stenosis rate of carotid artery (OR = 1.029,95% CI: 1.002-1.0558) MAP (OR = 1.030, 95% CI: 1.002-1.060), FPG (OR = 1.360, 95% CI: 1.011-1.829), TC (OR = 1.803, 95% CI (OR = 1.99, CI: 1.017 ~ 2.673), FI (OR = 2.490,95% CI: 1.437-4.315), DD (OR = 1.002,95% CI: 1.000-1.004) 1.206) and BNP (OR = 1.001, 95% CI: 1.000-1.002) were the risk factors of stroke. The differences were statistically significant (P <0.05, P <0.01). In the progressive stroke group, the incidence of complete anterior circulation infarction (46.95%) and major vascular sclerosis (51.30%) was the highest. Conclusions Diabetes mellitus, carotid artery stenosis, maximal infarction diameter, and elevated levels of MAP, FPG, TC, FI, D-D, hs-CRP and BNP are independent risk factors for stroke and are sensitive indicators for predicting progressive stroke. Large anterior circulation cerebral infarction is also an important factor in predicting the progress of stroke patients.