Neurology Service, Center Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
J Neurol. 2012 Mar;259(3):524-9. doi: 10.1007/s00415-011-6216-5. Epub 2011 Aug 30.
A large number of parameters have been identified as predictors of early outcome in patients with acute ischemic stroke. In the present work we analyzed a wide range of demographic, metabolic, physiological, clinical, laboratory and neuroimaging parameters in a large population of consecutive patients with acute ischemic stroke with the aim of identifying independent predictors of the early clinical course. We used prospectively collected data from the Acute Stroke Registry and Analysis of Lausanne. All consecutive patients with ischemic stroke admitted to our stroke unit and/or intensive care unit between 1 January 2003 and 12 December 2008 within 24 h after last-well time were analyzed. Univariate and multivariate analyses were performed to identify significant associations with the National Institute of Health Stroke Scale (NIHSS) score at admission and 24 h later. We also sought any interactions between the identified predictors. Of the 1,730 consecutive patients with acute ischemic stroke who were included in the analysis, 260 (15.0%) were thrombolyzed (mostly intravenously) within the recommended time window. In multivariate analysis, the NIHSS score at 24 h after admission was associated with the NIHSS score at admission (β = 1, p < 0.001), initial glucose level (β = 0.05, p < 0.002) and thrombolytic intervention (β = -2.91, p < 0.001). There was a significant interaction between thrombolysis and the NIHSS score at admission (p < 0.001), indicating that the short-term effect of thrombolysis decreases with increasing initial stroke severity. Thrombolytic treatment, lower initial glucose level and lower initial stroke severity predict a favorable early clinical course. The short-term effect of thrombolysis appears mainly in minor and moderate strokes, and decreases with increasing initial stroke severity.
大量参数已被确定为急性缺血性脑卒中患者早期预后的预测因子。在本工作中，我们分析了大量连续急性缺血性脑卒中患者的广泛的人口统计学、代谢、生理、临床、实验室和神经影像学参数，旨在确定早期临床病程的独立预测因子。我们使用急性脑卒中登记和洛桑分析前瞻性收集的数据。2003 年 1 月 1 日至 2008 年 12 月 12 日期间，在最后一次良好时间后 24 小时内，我们分析了连续入住我院卒中病房和/或重症监护病房的所有缺血性脑卒中患者。进行单变量和多变量分析，以确定与入院时和 24 小时后 NIHSS 评分的显著相关性。我们还寻求确定的预测因子之间的任何相互作用。在纳入分析的 1730 例连续急性缺血性脑卒中患者中，260 例（15.0%）在推荐的时间窗内接受溶栓治疗（主要为静脉内溶栓）。多变量分析显示，入院后 24 小时 NIHSS 评分与入院时 NIHSS 评分（β=1，p<0.001）、初始血糖水平（β=0.05，p<0.002）和溶栓干预（β=-2.91，p<0.001）相关。溶栓治疗和入院时 NIHSS 评分之间存在显著的交互作用（p<0.001），表明溶栓治疗的短期效果随初始卒中严重程度的增加而降低。溶栓治疗、较低的初始血糖水平和较低的初始卒中严重程度预测早期临床病程良好。溶栓治疗的短期效果主要见于轻度和中度脑卒中，并且随着初始卒中严重程度的增加而降低。
