急性缺血性脑卒中患者脑微出血与早期神经功能恶化的相关性研究
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摘要
目的研究急性缺血性脑卒中患者脑微出血(cerebral microbleeds,CMBs)与早期神经功能恶化(Early neurological deterioration,END)的相关性。方法前瞻性连续入组陕西省人民医院2018年3月至2018年8月收治的急性缺血性脑卒中患者94例,收集其临床资料,根据患者是否出现END分为END组25例和非END组69例,探讨微出血灶的位置、数量等与END的相关性。结果单因素分析结果提示两组患者高血压(χ~2=9.264,P=0.002)、糖尿病(χ~2=4.321,P=0.038)、糖化血红蛋白(t=2.386,P=0.019)、入院基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(t=4.145,P=0.002)、同型半胱氨酸(homocysteine,HCY)(t=2.817,P=0.006)、脑微出血(χ~2=8.839,P=0.032)差异有统计学意义。进一步行多因素logistic回归分析提示高血压(OR=9.678,CI=2.541～36.856,P=0.002)、糖尿病(OR=1.374,CI=1.041～7.065,P=0.042),HCY>15umol/L(OR=4.535,CI=1.354～8.167,P=0.031)、入院基线NIHSS评分>3(OR=0.270,CI=0.076～3.952,P=0.028)、CMBs病灶数>10(OR=2.867,CI=0.322～9.135,P=0.035)是缺血性卒中患者发生END的独立危险因素。结论 CMBs可能与急性缺血性脑卒中患者早期神经功能恶化相关,而10个以上CMBs可能是早期神经功能恶化的独立危险因素。
Objective To investigat the correlation between cerebral microbleeds(CMBs) and early neurologic function deterioration(END) with acute ischemic stroke. Method 94 patients with acute ischemic stroke hospitalized in shaanxi provincial people's hospital after occurrence from March 2018 to August 2018 were prospectively enrolled.The baseline clinical data、imaging and laboratory test results in patients were collected. According to whether END occurs in patients, there are 25 cases in the END group and 69 cases in the non-end group. The relationship between cerebral microbleeds and early neurologic function deterioration was analyzed. Results Univariate analysis showed there were significant difference between the two groups in Hypertension(χ~2=9.264, P=0.002),diabetes(χ~2=4.321, P=0.038), glycosylated hemoglobin(t=2.386, P=0.019) as well as baseline NIHSS score(t=4.145, P=0.002), homocysteine, HCY(t=2.817, P=0.006),cerebral microbleeds(χ~2=8.839, P=0.032). Logistic regression analysis inicated that hypertension(OR=9.678, CI=2.541～36.856, P=0.002), diabetes(OR=1.374,CI=1.041～7.065, P=0.042,) HCY>15umol/L(OR=4.535, CI=1.354～8.167, P=0.031)、 baseline NIHSS score>3(OR=0.270,CI= 0.076 ～ 3.952, P=0.028), and CMBs foci numbers >10(OR=2.867, CI=0.322 ～ 9.135, P=0.035) were independent risk factors for occurring END in patients with acut ischemic stroke. Conclusion CMBs may be associated with early deterioration of neurological function in patients with acute ischemic stroke, and more than 10 CMBs may be independent risk factor for early deterioration of neurological function.
Objective To investigat the correlation between cerebral microbleeds(CMBs) and early neurologic function deterioration(END) with acute ischemic stroke. Method 94 patients with acute ischemic stroke hospitalized in shaanxi provincial people's hospital after occurrence from March 2018 to August 2018 were prospectively enrolled.The baseline clinical data、imaging and laboratory test results in patients were collected. According to whether END occurs in patients, there are 25 cases in the END group and 69 cases in the non-end group. The relationship between cerebral microbleeds and early neurologic function deterioration was analyzed. Results Univariate analysis showed there were significant difference between the two groups in Hypertension(χ~2=9.264, P=0.002),diabetes(χ~2=4.321, P=0.038), glycosylated hemoglobin(t=2.386, P=0.019) as well as baseline NIHSS score(t=4.145, P=0.002), homocysteine, HCY(t=2.817, P=0.006),cerebral microbleeds(χ~2=8.839, P=0.032). Logistic regression analysis inicated that hypertension(OR=9.678, CI=2.541～36.856, P=0.002), diabetes(OR=1.374,CI=1.041～7.065, P=0.042,) HCY>15umol/L(OR=4.535, CI=1.354～8.167, P=0.031)、 baseline NIHSS score>3(OR=0.270,CI= 0.076 ～ 3.952, P=0.028), and CMBs foci numbers >10(OR=2.867, CI=0.322 ～ 9.135, P=0.035) were independent risk factors for occurring END in patients with acut ischemic stroke. Conclusion CMBs may be associated with early deterioration of neurological function in patients with acute ischemic stroke, and more than 10 CMBs may be independent risk factor for early deterioration of neurological function.
引文
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[12]Charidimou A, Kakar P, Fox Z, et al. Cerebral microbleeds and recurrent stroke risk:systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts[J]. Stroke,2013,44(4):995-1001.
[13]Del BA, Palumbo V, Lamassa M, et al. Progressive lacunar stroke:review of mechanisms, prognostic features, and putative treatments[J]. Int J Stroke,2012,7(4):321-9.
[14]Pantoni L. Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges[J]. Lancet Neurol,2010,9(7):689-701.
[15]Huang Z, Yin Q, Sun W, et al. Microbleeds in ischemic stroke are associated with lower serum adiponectin and higher soluble E-selectin levels[J]. J Neurol Sci,2013,334(1-2):83-7.
[16]Wang DN, Hou XW, Yang BW,et al. Quantity of Cerebral Microbleeds,Antiplatelet Therapy, and Intracerebral Hemorrhage Outcomes:A Systematic Review and Meta-analysis[J]. J Stroke Cerebrovasc Dis, 2015,24(12):2728-37.
[2]Yi X, Han Z, Zhou Q, et al. 20-Hydroxyeicosatetraenoic Acid as a Predictor of Neurological Deterioration in Acute Minor Ischemic Stroke[J].Stroke,2016,47(12):3045-3047.
[3]Yi X, Wang C, Liu P, et al. Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population[J]. J Neurol,2016,263(8):1612-9.
[4]Seners P, Baron JC, AUID-Oho. Revisiting ‘progressive stroke’:incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke[J]. J Neurol,2018,265(1):216-225.
[5]Stefaniak JD, Su L, Mak E, et al. Cerebral small vessel disease in middle age and genetic predisposition to late-onset Alzheimer’s disease[J]. Alzheimers Dement,2018,14(2):253-258.
[6]Miwa K, Tanaka M, Okazaki S,et al. Relations of blood inflammatory marker levels with cerebral microbleeds[J]. Stroke,2011,42(11):3202-6.
[7]姜娜. SWI在预测缺血性脑卒中出血性转化中的价值[J].内蒙古中医药,2014,33(15):99-100.
[8]Poels MM, Vernooij MW, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds:an update of the Rotterdam scan study[J]. Stroke,2010,41(10 Suppl):S103-6.
[9]Rocco A, Fam G, Sykora M, et al. Poststroke infections are an independent risk factor for poor functional outcome after three-months in thrombolysed stroke patients[J]. Int J Stroke,2013,8(8):639-44.
[10]Baker JG, Williams AJ, Ionita CC, et al. Cerebral small vessel disease:cognition, mood, daily functioning, and imaging findings from a small pilot sample[J]. Dement Geriatr Cogn Dis Extra,2012,2:169-79.
[11]韩忠奎,任明山,夏元亮,等.首发急性腔隙性脑梗死患者脑微出血与早期神经功能恶化的关联研究[J].医学研究生学报,2015,(11):1160-1163.
[12]Charidimou A, Kakar P, Fox Z, et al. Cerebral microbleeds and recurrent stroke risk:systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts[J]. Stroke,2013,44(4):995-1001.
[13]Del BA, Palumbo V, Lamassa M, et al. Progressive lacunar stroke:review of mechanisms, prognostic features, and putative treatments[J]. Int J Stroke,2012,7(4):321-9.
[14]Pantoni L. Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges[J]. Lancet Neurol,2010,9(7):689-701.
[15]Huang Z, Yin Q, Sun W, et al. Microbleeds in ischemic stroke are associated with lower serum adiponectin and higher soluble E-selectin levels[J]. J Neurol Sci,2013,334(1-2):83-7.
[16]Wang DN, Hou XW, Yang BW,et al. Quantity of Cerebral Microbleeds,Antiplatelet Therapy, and Intracerebral Hemorrhage Outcomes:A Systematic Review and Meta-analysis[J]. J Stroke Cerebrovasc Dis, 2015,24(12):2728-37.