大动脉粥样硬化型觉醒型卒中患者危险因素及预后相关性研究
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摘要
目的研究大动脉粥样硬化型觉醒型卒中患者危险因素及预后。方法选择2017年1月~2018年1月在本院神经内科住院治疗的急性脑梗死患者200例,根据CT和MRI影像数据结果、CISS分型(改良TOAST)特点及患者发生脑梗死的发病时间,将其分为大动脉粥样硬化型觉醒型卒中组(100例)和大动脉粥样硬化型清醒时卒中组(100例)。统计两组患者的神经功能缺损严重程度(NIHSS评分)、年龄、性别、家族史、高血压病、糖尿病、高脂血症、短暂性脑缺血发作(TIA)、吸烟、饮酒史、高同型半胱氨酸血症等,并作为危险因素统计各因素在两组中所占比例。治疗3个月后对所有入选的患者进行随访,统计所有患者NIHSS评分及病死率。结果经分析,性别、年龄、糖尿病是导致觉醒型卒中发生的危险因素,两组比较差异具有统计学意义(P<0.05)。随访3个月后,两组患者NIHSS评分均显著降低,且觉醒型卒中组明显高于清醒时卒中组,两组比较差异有统计学意义(P<0.05);觉醒型卒中组死亡率为3.00%,清醒时卒中组死亡率为4%,两组比较差异无统计学意义(P>0.05)。经Cox回归分析,年龄为影响卒中患者预后的独立危险因素,两组比较差异有统计学意义(P<0.05)。结论在觉醒型卒中与清醒时卒中众多危险因素下,性别、年龄、糖尿病是导致觉醒型卒中发生的危险因素,年龄为影响患者预后的独立危险因素,且觉醒型卒中后循环发病比例较高,神经功能恢复较差,对其进行影像观察尽可能使用静脉溶栓治疗模式具有重要的临床意义。
Objective To study the risk factors and prognosis factors in patients with large artery atherosclerosis wake-up stroke. Methods Patients with acute cerebral infarction who received therapy from January 2017 to January 2018 in our hospital were selected. According to the results of CT and MRI image data,CISS classification and timecourse of cerebral infarction,the patients were divided into large artery atherosclerosis wake-up stroke group(100) and large artery atherosclerosis waking stroke group(100). NIHSS score,age,gender,family history,hypertension,diabetes,hyperlipidemia,transient ischemic attack(TIA),history of smoking,drinking alcohol,high homocysteine levels in two groups were analzyed. The proportion of the factors in the two groups was calculated as a risk factor. All selected patients were followed up for 3 months and the NIHSS score and mortality were statistically calculated. Results By the analysis of type in the waking stroke and wake-up strok,stroke of gender,age,diabetes were the risk factors of wake-up stroke. After three months,NIHSS scores were significantly lower in both groups,and the scores was significantly higher in the wake-up sroke group than those in waking stroke group(P < 0.05). The mortality of wake-up stroke group was 3.00%,and the mortality rate of waking stroke group was 4%,and the difference between the two groups was not statistically significant(P >0.05). After Cox regression analysis,age was an independent risk factor of the prognosis of stroke patients(P < 0.05). Conclusion There are many risk factors for wake-up stroke and waking stroke,their gender,age,diabetes is a risk factor for stroke,age is an independent risk factor affecting the prognosis of patients,lead to awakening type type and awakening cycle after stroke incidence rate is higher,neural functional recovery is poorer,video observation as far as possible to the use of intravenous thrombolysis treatment mode is of important clinical significance.
Objective To study the risk factors and prognosis factors in patients with large artery atherosclerosis wake-up stroke. Methods Patients with acute cerebral infarction who received therapy from January 2017 to January 2018 in our hospital were selected. According to the results of CT and MRI image data,CISS classification and timecourse of cerebral infarction,the patients were divided into large artery atherosclerosis wake-up stroke group(100) and large artery atherosclerosis waking stroke group(100). NIHSS score,age,gender,family history,hypertension,diabetes,hyperlipidemia,transient ischemic attack(TIA),history of smoking,drinking alcohol,high homocysteine levels in two groups were analzyed. The proportion of the factors in the two groups was calculated as a risk factor. All selected patients were followed up for 3 months and the NIHSS score and mortality were statistically calculated. Results By the analysis of type in the waking stroke and wake-up strok,stroke of gender,age,diabetes were the risk factors of wake-up stroke. After three months,NIHSS scores were significantly lower in both groups,and the scores was significantly higher in the wake-up sroke group than those in waking stroke group(P < 0.05). The mortality of wake-up stroke group was 3.00%,and the mortality rate of waking stroke group was 4%,and the difference between the two groups was not statistically significant(P >0.05). After Cox regression analysis,age was an independent risk factor of the prognosis of stroke patients(P < 0.05). Conclusion There are many risk factors for wake-up stroke and waking stroke,their gender,age,diabetes is a risk factor for stroke,age is an independent risk factor affecting the prognosis of patients,lead to awakening type type and awakening cycle after stroke incidence rate is higher,neural functional recovery is poorer,video observation as far as possible to the use of intravenous thrombolysis treatment mode is of important clinical significance.
引文
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[11]张春阳,张会岭,石秋艳,等.觉醒型卒中患者发病时间及评估[J].临床内科杂志,2016,33(1):25-27.
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[13]张锦凤,刘国荣,李月春,等.应用核磁共振确定觉醒后缺血性脑卒中患者发病时间的研究[J].中华老年心脑血管病杂志,2015,(9):915-918.
[14]Yee J,Kumar V,Pham A,et al.Simultaneous onset of deep vein thrombosis,pulmonary embolism,cerebral infarction,and myocardial infarction in a patient with patent foramen ovale[J].S D Med,2017,70(6):266-269.
[15]白青科,赵振国,隋海晶,等.磁共振成像快速评价指导的觉醒型缺血性卒中患者的静脉溶栓治疗[J].中华神经科杂志,2014,47(7):455-459.
[16]刘伟,周正宏,史冬梅,等.阻塞性睡眠呼吸暂停与觉醒型卒中的关系分析[J].中国卒中杂志,2016,11(11):912-917.
[2]Pierot L,Gawlitza M,Soize S.Techniques for endovascular treatment of acute ischemic stroke[J].Rev Neurol(Paris),2017,173(9):594-599.
[3]饶明俐.中国脑血管病防治指南[M].北京:人民卫生出版社,2007:1-145.
[4]赵学栋,石秋艳,张春阳,等.磁共振成像指导觉醒型卒中患者静脉溶栓的安全性及预后分析[J].中国煤炭工业医学杂志,2016,19(5):679-683.
[5]张然,郭力.觉醒型卒中的研究进展[J].医学综述,2016,22(18):3603-3606.
[6]李雨晴,张佩兰.重组组织型纤溶酶原激活剂静脉溶栓治疗觉醒型卒中患者的安全性和有效性[J].实用医学杂志,2016,32(22):3765-3768.
[7]Zhang W,Huang Y,Li Y,et al.Efficacy and safety of vinpocetine as part of treatment for acute cerebral infarction:a randomized,open-label,controlled,multicenter CAVIN(Chinese Assessment for Vinpocetine in Neurology)trial[J].Clin Drug Investig,2016,36(9):697-704.
[8]Wu W,Guan Y,Xu K,et al.Plasma homocysteine levels predict the risk of acute cerebral infarction in patients with carotid artery lesions[J].Mol Neurobiol,2016,53(4):2510-1517.
[9]张玉生,董大伟,李牧,等.觉醒型卒中患者溶栓治疗进展[J].中华内科杂志,2013,52(1):74-75.
[10]程圆,苏丹.觉醒型卒中的临床影像学研究及治疗进展[J].中华老年心脑血管病杂志,2015,17(12):1340-1342.
[11]张春阳,张会岭,石秋艳,等.觉醒型卒中患者发病时间及评估[J].临床内科杂志,2016,33(1):25-27.
[12]Okazaki S,Yamagami H,Yoshimoto T,et al.Cerebral hyperperfusion on arterial spin labeling MRI after reperfusion therapy is related to hemorrhagic transformation[J].J Cereb Blood Flow Metab,2017,37(9):3087-3090.
[13]张锦凤,刘国荣,李月春,等.应用核磁共振确定觉醒后缺血性脑卒中患者发病时间的研究[J].中华老年心脑血管病杂志,2015,(9):915-918.
[14]Yee J,Kumar V,Pham A,et al.Simultaneous onset of deep vein thrombosis,pulmonary embolism,cerebral infarction,and myocardial infarction in a patient with patent foramen ovale[J].S D Med,2017,70(6):266-269.
[15]白青科,赵振国,隋海晶,等.磁共振成像快速评价指导的觉醒型缺血性卒中患者的静脉溶栓治疗[J].中华神经科杂志,2014,47(7):455-459.
[16]刘伟,周正宏,史冬梅,等.阻塞性睡眠呼吸暂停与觉醒型卒中的关系分析[J].中国卒中杂志,2016,11(11):912-917.