Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2013 Apr;22(3):205-10. doi: 10.1016/j.jstrokecerebrovasdis.2011.07.018. Epub 2011 Sep 8.
One-third of patients with acute ischemic stroke develop early neurologic worsening, which is associated with increased mortality and long-term functional disability. We investigated the predictive factors for neurologic deterioration in patients with acute ischemic stroke within 1 week of onset. We retrospectively investigated 643 patients who were admitted within 2 days of acute ischemic stroke between April 2007 and March 2010. Neurologic deterioration was defined as an increase of 4 points or more in the National Institutes of Health Stroke Scale (NIHSS) score within 1 week of admission. We retrieved data on demographic and clinical characteristics, medications, and stroke subtypes. Out of 537 patients, deterioration was noted in 64 patients (11.9%; deterioration group). Multivariate analysis identified history of myocardial infarction (P < .001), NIHSS score ≥8 at onset (P < .001), high leukocyte count (P = .035), low-density lipoprotein cholesterol ≥140 mg/dL (P = .002), and hemoglobin A1c ≥7% (P = .006) as significant factors associated with deterioration. Branch atheromatous disease was more frequent in the deterioration group, and >90% of patients with deterioration either were discharged to nursing home care or died. Multivariate analysis of magnetic resonance imaging findings identified internal carotid/middle cerebral artery occlusion (each P < .001), striate capsular infarction (P = .030), pontine infarction (P = .047), and lesion size of 15-30 mm (P = .011) as independent factors associated with deterioration. Stroke patients with a high low-density lipoprotein level, high hemoglobin A1c level on admission, a history of myocardial infarction, and high NIHSS score are at high risk for neurologic deterioration. Patients with multiple risk factors for deterioration can benefit most from intensive monitoring.
三分之一的急性缺血性脑卒中患者会出现早期神经功能恶化，这与死亡率增加和长期功能残疾有关。我们调查了发病后 1 周内急性缺血性脑卒中患者神经恶化的预测因素。我们回顾性调查了 2007 年 4 月至 2010 年 3 月期间发病后 2 天内入院的 643 例患者。神经恶化定义为入院后 1 周内 NIHSS 评分增加 4 分或以上。我们检索了人口统计学和临床特征、药物和卒中亚型的数据。在 537 例患者中，有 64 例（11.9%）出现恶化（恶化组）。多变量分析确定了心肌梗死史（P <.001）、发病时 NIHSS 评分≥8 分（P <.001）、白细胞计数高（P =.035）、低密度脂蛋白胆固醇≥140mg/dL（P =.002）和血红蛋白 A1c≥7%（P =.006）是与恶化相关的显著因素。恶化组中动脉粥样硬化性疾病更为常见，恶化患者中超过 90%的患者要么被转到疗养院护理，要么死亡。磁共振成像发现的多变量分析确定了颈内/大脑中动脉闭塞（各 P <.001）、纹状囊梗死（P =.030）、脑桥梗死（P =.047）和病变大小为 15-30mm（P =.011）是与恶化相关的独立因素。入院时低密度脂蛋白水平高、血红蛋白 A1c 水平高、有心肌梗死史和 NIHSS 评分高的卒中患者神经恶化风险高。有多个恶化危险因素的患者可以从强化监测中获益最大。
