急性大动脉闭塞性脑梗死患者血管再通治疗后早期神经功能恶化的影响因素分析

doi:10.3969/j.issn.1006-6233.2021.11.08

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摘要 目的: 探讨影响急性大动脉闭塞性脑梗死患者血管再通治疗后早期神经功能恶化的因素,为不良预后的早期识别提供参考。方法: 选取2017年10月至2020年10月在我院神经内科就诊的前循环大动脉闭塞性脑梗死患者120例为研究对象,根据患者再通治疗后是否发生早期神经功能恶化(early neurological deterioration,END)将患者分为END组和非END组,其中END组32例,非END组88例,比较两组患者的临床资料,通过Logistic回归分析影响END发生的危险因素,对差异有统计学意义的变量进行赋值,采用R软件(R3.3.2)和软件包rms构建列线图预测模型。采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)、一致性指数(Consistency index,C-index)和校准图对预测模型进行验证。结果: Logistic回归分析结果显示年龄 ≥ 65岁、收缩压 ≥ 140 mmHg、NIHSS评分≥20分、发生大面积脑梗死、NLR≥4.20是脑梗死患者溶栓治疗后发生END的独立危险因素。根据上述危险因素构建的溶栓治疗后发生END风险预测列线图模型区分度好,与实际观测值的一致性较高。结论: 溶栓前患者年龄、收缩压、NIHSS评分、大面积脑梗死及NLR是影响患者发生END的独立危险因素,临床上需要警惕。

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	陈敏
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关键词 ：脑梗死, 血管再通, 早期神经功能恶化, 列线图

Abstract：Objective: To explore the factors affecting the early neurological deterioration(END) after vascular recanalization treatment in patients with acute aortic occlusion cerebral infarction, and to provide reference for the early identification of poor prognosis. Methods: A total of 120 patients with anterior circulation major artery occlusive cerebral infarction admitted to the Department of Neurology of our hospital from October 2017 to October 2020 were selected as the research subjects. According to whether the recanalization after treatment in patients with occurrence of END the patients were divided into the END group with 32 cases and the non-END group with 88 cases. The clinical data of two groups of patients were compared, and analysis of dangerous factors was conducted with Logistic regression. Variables of statistical significance were assigned values, and prediction model was made with R software (R3.3.2) and package RMS and verified with receiver operating characteristic curve (ROC), consistency index (C-index) and calibration diagram. Results: Logistic regression analysis showed that age ≥ 65 years, systolic blood pressure ≥ 140 mmHg, NIHSS score ≥20 points, large area of cerebral infarction and NLR ≥4.20 were independent risk factors for the occurrence of END after thrombolytic therapy in patients with cerebral infarction. The histogram model of risk prediction of END after thrombolytic therapy constructed according to the above risk factors has good differentiation and high consistency with the actual observed values. Conclusion: Age, systolic blood pressure, NIHSS score, large area of cerebral infarction and NLR before thrombolysis are independent risk factors for the occurrence of END in patients, which need to be vigilant about clinically.

Key words： Cerebral infarction Recanalization of blood vessels Early neurological deterioration Column chart

基金资助:四川省科技计划项目,(编号:2020YFS0155)

通讯作者: 冯灵

引用本文:

陈敏, 冯灵, 涂双燕, 汪锐. 急性大动脉闭塞性脑梗死患者血管再通治疗后早期神经功能恶化的影响因素分析[J]. 河北医学, 2021, 27(11): 1801-1806.
CHEN Min, FENG Ling, TU Shuangyan, et al. An Analysis of Influencing Factors of Early Neurological Deterioration After Revascularization in Patients with Acute Large Artery Occlusive Cerebral Infarction. HeBei Med, 2021, 27(11): 1801-1806.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.11.08 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I11/1801

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