住院期间神经功能恶化的预测因素：来自中国颅内动脉粥样硬化（CICAS）研究的结果。

Predictors of neurological deterioration during hospitalization: results from the Chinese Intracranial Atherosclerosis (CICAS) Study.

作者信息

Ma Yuetao, Liu Liping, Pu Yuehua, Zou Xinying, Pan Yuesong, Soo Yannie, Zhao Xingquan, Wang Yilong, Wong Kasing, Wang Yongjun

出版信息

Neurol Res. 2015 May;37(5):385-90. doi: 10.1179/1743132815Y.0000000024. Epub 2015 Apr 28.

DOI:10.1179/1743132815Y.0000000024

PMID:25917464

Abstract

OBJECTIVES

Neurological deterioration (ND) after ischaemic stroke has been indicated as an independent risk factor for poor outcome. Previous studies have focussed on ND within the first few days after symptom onset, but many patients are likely to experience deterioration outside of this time frame. We aimed to investigate the predictors of ND during hospitalisation.

METHODS

Data were obtained from the Chinese Intracranial Atherosclerosis (CICAS) Study, and patients who were diagnosed with ischaemic stroke and arrived at the hospital within 72 hours after symptom onset were included in the present study. Neurological deterioration was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points at discharge compared with admission. MR angiography (MRA) and duplex colour Doppler ultrasound were used to document the presence of intracranial or extracranial artery stenosis. Intracranial artery stenosis was defined as a reduction in the artery diameter of ≥ 50% on MRA. Multivariate analyses were conducted to determine the potential predictors of ND during hospitalisation.

RESULTS

Of the 1996 patients included in this study, 84 (4.21%) developed ND during hospitalisation. Compared with non-ND patients, ND patients showed higher rates of pneumonia (25.0 vs 9.5%, P < 0.001), urinary infection (7.1 vs 1.2%, P < 0.01), stroke recurrence (14.3 vs 1.9%, P < 0.001), watershed infarct (15.5 vs 5.4%, P = 0.002), intracranial internal carotid artery (ICA) stenosis (11.9 vs 6.0%, P = 0.041), middle cerebral artery (MCA) stenosis (39.3 vs 22.0%, P < 0.001) and basilar artery (BA) stenosis (16.7 vs 7.1%, P = 0.011). Multivariate analysis indicated that watershed infarcts (OR, 2.85; 95% CI, 1.04-7.81), MCA (OR, 2.23; 95% CI, 1.17-4.25) and BA (OR, 2.86; 95% CI, 1.19-6.87) stenosis or occlusion were independent risk factors for ND, as was pneumonia (OR, 3.4; 95% CI, 1.46-7.9).

DISCUSSION

Patients with watershed infarcts and MCA or BA stenosis or occlusion should be monitored closely, and various therapeutic strategies should be administered simultaneously to prevent pneumonia during hospitalisation.

摘要

目的

缺血性卒中后神经功能恶化（ND）已被视为预后不良的独立危险因素。以往研究主要关注症状发作后头几天内的神经功能恶化情况，但许多患者可能在此时间框架之外出现病情恶化。我们旨在调查住院期间神经功能恶化的预测因素。

方法

数据取自中国颅内动脉粥样硬化（CICAS）研究，本研究纳入了症状发作后72小时内入院且被诊断为缺血性卒中的患者。神经功能恶化定义为出院时美国国立卫生研究院卒中量表（NIHSS）评分较入院时增加≥2分。采用磁共振血管造影（MRA）和双功能彩色多普勒超声记录颅内或颅外动脉狭窄情况。颅内动脉狭窄定义为MRA显示动脉直径减少≥50%。进行多因素分析以确定住院期间神经功能恶化的潜在预测因素。

结果

本研究纳入的1996例患者中，84例（4.21%）在住院期间出现神经功能恶化。与未发生神经功能恶化的患者相比，发生神经功能恶化的患者肺炎发生率更高（25.0%对9.5%，P<0.001）、尿路感染发生率更高（7.1%对1.2%，P<0.01）、卒中复发率更高（14.3%对1.9%，P<0.001）、分水岭梗死发生率更高（15.5%对5.4%，P=0.002）、颅内颈内动脉（ICA）狭窄发生率更高（11.9%对6.0%，P=0.041）、大脑中动脉（MCA）狭窄发生率更高（39.3%对22.0%，P<0.001）以及基底动脉（BA）狭窄发生率更高（16.7%对7.1%，P=0.011）。多因素分析表明，分水岭梗死（比值比[OR]，2.85；95%置信区间[CI]，1.04 - 7.81）、MCA（OR，2.23；95%CI，1.17 - 4.25）和BA（OR，2.86；95%CI，1.19 - 6.87）狭窄或闭塞是神经功能恶化的独立危险因素，肺炎也是（OR，3.4；95%CI，1.46 - 7.9）。