本文選題：缺血性卒中　切入點：結(jié)局　出處：《中國腦血管病雜志》2017年08期

【摘要】：目的探討青年缺血性卒中患者早期不良結(jié)局的相關(guān)因素。方法回顧性連續(xù)納入2006年1月至2016年6月南京軍區(qū)南京總醫(yī)院神經(jīng)內(nèi)科住院的青年急性缺血性卒中(18~45歲)患者685例,均經(jīng)頭部CT或MRI確診為首次發(fā)病。根據(jù)患者出院90 d隨訪時改良Rankin量表(mRS),將其分為結(jié)局良好(mRS 0~2分)組(554例)和結(jié)局不良(mRS 3~6分)組(131例)。入院當(dāng)天完善臨床資料的收集,包括腦血管病危險因素(口服避孕藥等)、入院時美國國立衛(wèi)生研究院卒中量表(NIHSS)評分、住院后前3 d平均收縮壓(以140 mmHg進行分析)及實驗室檢查等。卒中亞型采用急性卒中低分子肝素試驗(TOAST)分型標(biāo)準(zhǔn)。采用單因素分析組間臨床資料的差異,并對早期不良結(jié)局的危險因素進行多因素Logistic回歸分析。結(jié)果與結(jié)局良好組比較,結(jié)局不良組住院后前3 d平均收縮壓140 mmHg者的比率[37.4%(49/131)比21.7%(120/554),χ~2=14.131]、入院時NIHSS評分[10.0(7.0,14.0)分比1.5(0,3.0)分,Z=-15.300]、白細(xì)胞計數(shù)[7.5(6.0,9.0)×10~9/L比6.8(5.7,8.2)×10~9/L,Z=-3.157]、空腹血糖[4.9(4.6,6.0)mmol/L比4.8(4.4,5.3)mmol/L,Z=-2.726]、纖維蛋白原水平[2.8(2.3,3.4)g/L比2.6(2.3,3.2)g/L,Z=-2.018]較高,血尿酸[291(220,346)mmol/L比315(261,374)mmol/L,Z=-3.443]和血漿白蛋白水平[43.1(40.0,45.9)g/L比44.8(42.4,47.4)g/L,Z=-4.708]降低,組間差異均有統(tǒng)計學(xué)意義(均P0.05)。TOAST分型比較,結(jié)局不良組心源性栓塞患者比例高于結(jié)局良好組,組間差異有統(tǒng)計學(xué)意義[6.9%(9/131)比2.5%(14/554),χ~2=4.893,P0.05]。其余臨床資料的組間差異均無統(tǒng)計學(xué)意義(均P0.05)。多因素Logistic回歸分析結(jié)果顯示,入院時NIHSS評分較高(OR=1.474,95%CI:1.378~1.576,P0.01)、入院后前3 d平均收縮壓140 mmHg(OR=2.134,95%CI:1.210~3.764,P=0.009)、心源性栓塞(OR=4.902,95%CI:1.073~22.222,P=0.040)是早期不良結(jié)局的危險因素,而血漿白蛋白水平升高(OR=0.902,95%CI:0.850~0.956,P=0.001)是早期良好結(jié)局的保護因素。結(jié)論入院時NIHSS評分較高、心源性栓塞和入院后前3 d平均收縮壓升高可能是青年缺血性卒中患者早期結(jié)局不良的獨立危險因素,而血漿白蛋白水平升高有利于其早期結(jié)局。
[Abstract]:Objective to explore the related factors of early adverse outcome in young patients with ischemic stroke.Methods from January 2006 to June 2016, a total of 685 young patients with acute ischemic stroke (1845 years old) admitted to the Department of Neurology, Nanjing General Hospital of Nanjing military region from 2006 to June 2016, were all diagnosed as the first onset by CT or MRI.According to the modified Rankin scale for 90 days after discharge, the patients were divided into two groups: 554 patients with good outcome (0 ~ 2)) and 131 patients with poor outcome (3 ~ 6).On the day of admission, we completed the collection of clinical data, including the risk factors of cerebrovascular disease (oral contraceptive pills, etc.), and the NIHSS score of the National Institutes of Health Stroke scale at admission.The mean systolic blood pressure (analysed by 140 mmHg) and laboratory examination in the first 3 days after hospitalization.The subtype of stroke was classified by acute stroke low molecular weight heparin test (TOAST).Single factor analysis was used to analyze the difference of clinical data and multivariate Logistic regression analysis was used to analyze the risk factors of early adverse outcome.緇撴灉涓庣粨灞，

本文編號：1725812