Inatomi Y, Yonehara T, Omiya S, Hashimoto Y, Hirano T, Uchino M
Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Cerebrovasc Dis. 2008;25(4):316-23. doi: 10.1159/000118376. Epub 2008 Feb 27.
We investigated the incidence, clinical characteristics, outcome and factors associated with aphasia and early improvement in acute ischemic stroke.
We consecutively studied 855 patients with acute ischemic stroke who were admitted to our hospital within 48 h after onset and who were not comatose on admission. Assessment of aphasia was performed on admission (day 0) and day 10. We examined the incidence, severity, and subtypes of aphasia, and compared the clinical background of patients with and without aphasia on admission, and also those with and without early improvement by day 10. In addition, we investigated the independent factors associated with the presence of aphasia on admission and with early improvement.
Of the 855 patients, 130 (15.2%) had aphasia on admission. The National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.21; 95% CI 1.17-1.26) was a significant and independent factor associated with the presence of aphasia on admission. Early improvement was seen in 56 of 121 aphasic patients (46.3%) who were still alive on day 10. A history of hypercholesterolemia (OR 3.27; 95% CI 1.14-9.39) was a significant and independent factor associated with early improvement in aphasia during the acute phase and NIHSS on admission (OR 0.95; 95% CI 0.90-0.99) was marginally significant.
It is difficult to predict the outcome of aphasia within the first few days after the onset of ischemic stroke.
我们调查了急性缺血性卒中后失语症的发病率、临床特征、转归以及与失语症和早期改善相关的因素。
我们连续研究了855例急性缺血性卒中患者，这些患者在发病后48小时内入院且入院时未昏迷。在入院时（第0天）和第10天对失语症进行评估。我们检查了失语症的发病率、严重程度和亚型，并比较了入院时有失语症和无失语症患者的临床背景，以及到第10天有早期改善和无早期改善患者的临床背景。此外，我们调查了与入院时失语症的存在以及早期改善相关的独立因素。
855例患者中，130例（15.2%）入院时患有失语症。入院时的美国国立卫生研究院卒中量表（NIHSS）评分（比值比1.21；95%置信区间1.17 - 1.26）是与入院时失语症存在相关的显著且独立的因素。在第10天仍存活的121例失语症患者中，56例（46.3%）有早期改善。高胆固醇血症病史（比值比3.27；95%置信区间1.14 - 9.39）是急性期失语症早期改善的显著且独立的因素，入院时的NIHSS评分（比值比0.95；95%置信区间0.90 - 0.99）有边缘显著性。
在缺血性卒中发病后的最初几天内很难预测失语症的转归。
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