Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
J Neurol Sci. 2009 Dec 15;287(1-2):147-50. doi: 10.1016/j.jns.2009.08.006. Epub 2009 Sep 8.
Since attention should be paid to acute stroke patients who may easily worsen, we investigated the predisposing factors for acute deterioration of minor ischemic stroke in Japanese patients.
We retrospectively investigated 543 patients who were admitted within 7 days of the occurrence of an acute minor stroke with National Institute of Health Stroke Scale (NIHSS) score of 4 or less, between January 2002 and September 2005. Deterioration of neurological findings was defined as the worsening by 2 points or more of the NIHSS score during admission to the hospital.
Out of 543 patients, deterioration was noted in 37 patients (6.8%: deterioration group), and not in the other 506 patients (93.2%: non-deterioration group). Multivariate analysis demonstrated that the factors associated with worsening were atherothrombotic brain infarction (deterioration group vs. non-deterioration group: 35.1% vs. 18.0%, P=0.049), elevated systolic blood pressure (170.5+/-32.4 mm Hg vs. 160.4+/-27.4 mm Hg, P=0.033), serum glucose level on admission (146.1+/-60.5mg/dL vs. 121.7+/-54.9 mg/dL, P=0.048), and presence of paralysis (73.0% vs. 54.9%, P=0.003) and vertigo (16.2% vs. 7.9%, P=0.034). The more factors there were that were associated with worsening (atherothrombotic infarction; systolic blood pressure >140 mm Hg; serum glucose level >140 mg/dL; and paralysis, vertigo, and dizziness), the more frequently the deterioration occurred (number of worsening factors 0-2: 4.6%, 3: 12.8%, 4: 32.3%). Although over 80% of patients in the group without deterioration had good functional outcome at discharge, over 90% of patients with deterioration either were discharged to nursing home care or died.
In this study, the predisposing factors for acute deterioration in minor ischemic stroke were atherothrombotic brain infarction; high blood pressure; elevated serum glucose level; and paralysis, vertigo, and dizziness. Once patients with minor ischemic stroke deteriorated, their functional outcome at discharge was significantly worse than those who had not deteriorated.
由于需要关注可能容易恶化的急性脑卒中患者，我们对日本患者中轻度缺血性脑卒中急性恶化的诱发因素进行了研究。
我们回顾性调查了 2002 年 1 月至 2005 年 9 月期间发病后 7 天内入院的 NIHSS 评分≤4 分的 543 例急性轻度脑卒中患者。神经功能恶化定义为入院期间 NIHSS 评分恶化≥2 分。
543 例患者中，37 例（6.8%：恶化组）恶化，506 例（93.2%：非恶化组）未恶化。多变量分析显示，与恶化相关的因素为动脉粥样硬化血栓性脑梗死（恶化组与非恶化组：35.1%比 18.0%，P=0.049）、收缩压升高（170.5+/-32.4mmHg 比 160.4+/-27.4mmHg，P=0.033）、入院时血糖水平（146.1+/-60.5mg/dL 比 121.7+/-54.9mg/dL，P=0.048）和瘫痪（73.0%比 54.9%，P=0.003）和眩晕（16.2%比 7.9%，P=0.034）。与恶化相关的因素越多（动脉粥样硬化血栓性脑梗死；收缩压>140mmHg；血糖水平>140mg/dL；瘫痪、眩晕和头晕），恶化的发生率越高（恶化因素 0-2 个：4.6%，3 个：12.8%，4 个：32.3%）。虽然恶化组中超过 80%的患者出院时功能预后良好，但恶化组中超过 90%的患者要么出院到疗养院护理，要么死亡。
在本研究中，轻度缺血性脑卒中急性恶化的诱发因素为动脉粥样硬化血栓性脑梗死；高血压；高血糖水平；以及瘫痪、眩晕和头晕。一旦轻度缺血性脑卒中患者恶化，其出院时的功能预后明显差于未恶化的患者。
