Yamamoto Nobuaki, Satomi Junichiro, Yamamoto Yuki, Shono Kenji, Kanematsu Yasuhisa, Izumi Yuishin, Nagahiro Shinji, Kaji Ryuji
Department of Clinical Neurosciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1801-1806. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.011. Epub 2017 May 2.
In some patients with acute ischemic stroke, neurological deterioration (ND) is observed, and it is difficult to predict at the time of admission. Especially in some patients with large-artery atherosclerosis (LAA), aggressive medical treatments and surgical interventions might be helpful to prevent ND. Therefore, we investigated factors associated with ND in patients with LAA.
We studied patients with LAA who were admitted to our hospital. We divided them into 2 groups with (group 1) and without deterioration (group 2), and evaluated their medical records, risk factors, and radiological findings, such as number of diffusion-positive lesion and degree of stenosis.
Our study population consisted of 171 patients; 71 (41.5%) did and 100 (58.5%) did not suffer deterioration. By univariate analysis, blood pressure (BP), heart rate, National Institutes of Health Stroke Scale (NIHSS) score, number of diffusion-positive lesion, count of red blood cell, high-density lipoprotein, and degree of stenosis differed significantly between the 2 groups. By multivariate analysis, systolic BP (≥170 mm Hg, odds ratio: 7.20, P <.001) was associated with ND. Furthermore, number of diffusion-weighted image (DWI)-positive lesion (≥8), degree of stenosis (>80.0%), and NIHSS score (≥4) were also independent factors associated with ND.
High BP, severity of neurological deficit at the time of admission, and radiological findings, such as degree of stenosis and number of DWI-positive lesion, are independently associated with ND in patients with LAA.
在一些急性缺血性卒中患者中，会观察到神经功能恶化（ND），且在入院时难以预测。尤其是在一些大动脉粥样硬化（LAA）患者中，积极的药物治疗和手术干预可能有助于预防ND。因此，我们研究了LAA患者中与ND相关的因素。
我们研究了我院收治的LAA患者。将他们分为有神经功能恶化组（第1组）和无神经功能恶化组（第2组），并评估他们的病历、危险因素和影像学检查结果，如弥散阳性病变数量和狭窄程度。
我们的研究人群包括171例患者；71例（41.5%）出现神经功能恶化，100例（58.5%）未出现恶化。单因素分析显示，两组之间的血压（BP）、心率、美国国立卫生研究院卒中量表（NIHSS）评分、弥散阳性病变数量、红细胞计数、高密度脂蛋白和狭窄程度存在显著差异。多因素分析显示，收缩压（≥170 mmHg，比值比：7.20，P <.001）与ND相关。此外，弥散加权成像（DWI）阳性病变数量（≥8个）、狭窄程度（>80.0%）和NIHSS评分（≥4分）也是与ND相关的独立因素。
高血压、入院时神经功能缺损的严重程度以及影像学检查结果，如狭窄程度和DWI阳性病变数量，与LAA患者的ND独立相关。
