与大面积半球梗死良好预后相关的因素。
Factors associated with favourable outcome in large hemispheric infarctions.
作者信息
Li Jie, Zhang Ping, Wu Simiao, Yi Xingyang, Wang Chun, Liu Ming
机构信息
Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang, 618000, Sichuan Province, People's Republic of China.
Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China.
出版信息
BMC Neurol. 2018 Sep 20;18(1):152. doi: 10.1186/s12883-018-1148-7.
BACKGROUND
Large hemispheric infarction (LHI) is a devastating condition with high mortality and poor functional outcome in most conservatively treated patients. The purpose of this study was to explore factors associated with favorable outcome in patients with LHI.
METHODS
We prospectively enrolled consecutive patients with LHI. Favorable outcome was defined as a modified Rankin Scale (mRS) score of 0 to 3 at 90 days. Multivariate logistic regression analysis was employed to identify the independent factors associated with favorable outcome.
RESULTS
Two hundred fifty-six cases with LHI were identified: 41 (16.0%) died during hospitalization, 94 (36.7%) died at 3 month, and 113 (44.1%) survived with favorable outcome at day 90. Compared with patients with unfavorable outcome, the favorable cases were younger (55.8 ± 14.7 vs. 66.2 ± 14.1), had less history of hypertension (38.9% vs. 59.3%), lower baseline NIHSS score (median NIHSS score 11 vs. 17), lower blood pressure on admission (systolic 134.7 ± 24.9 vs. 145.1 ± 26.1 mmHg; diastolic 80.2 ± 14.9 vs. 86.9 ± 16.2 mmHg; respectively), lower level of baseline serum glucose (7.2 ± 3.3 vs. 8.2 ± 3.3 mmol/L), a lower frequency of stroke-related complications (55.8% vs. 91.4%), more use of antiplatelets (93.8% vs. 57.1%) and statins (46.9% vs. 25.7%) in the acute phase of stroke, but less use of osmotic agents (69.9% vs. 89.3%), mechanical ventilation (1.8% vs. 20.0%) or decompressive hemicraniectomy (1.8% vs. 15.7%). Multivariable analysis identified the following factors associated with favorable outcome: age (odds ratio, OR 0.95, 95% confidence interval [CI] 0.92-0.98, p < 0.001), baseline NIHSS score (OR 0.90, 95% CI 0.84-0.96, p = 0.002), statins used in acute phase (OR 2.49, 95% CI 1.10-5.65, p = 0.029), brain edema (OR 0.05, 95% CI 0.01-0.21, p < 0.001) and pneumonia (OR 0.42, 95% CI 0.19-0.93, p = 0.032).
CONCLUSION
More than one third of patients with LHI have relatively favorable clinical outcomes at 90 days. Younger age, lower baseline NIHSS score, absence of brain edema and pneumonia, and statins used in the acute phase were associated with favorable outcome of patients with LHI at 90 days.
背景
大面积半球梗死（LHI）是一种严重的疾病，大多数接受保守治疗的患者死亡率高且功能预后差。本研究的目的是探讨与LHI患者良好预后相关的因素。
方法
我们前瞻性地纳入了连续的LHI患者。良好预后定义为90天时改良Rankin量表（mRS）评分为0至3分。采用多因素逻辑回归分析来确定与良好预后相关的独立因素。
结果
共纳入256例LHI患者：41例（16.0%）在住院期间死亡，94例（36.7%）在3个月时死亡，113例（44.1%）在90天时存活且预后良好。与预后不良的患者相比，预后良好的患者更年轻（55.8±14.7岁对66.2±14.1岁），高血压病史较少（38.9%对59.3%），基线美国国立卫生研究院卒中量表（NIHSS）评分较低（NIHSS评分中位数11分对17分），入院时血压较低（收缩压134.7±24.9 mmHg对145.1±26.1 mmHg；舒张压80.2±14.9 mmHg对86.9±16.2 mmHg），基线血清葡萄糖水平较低（7.2±3.3 mmol/L对8.2±3.3 mmol/L），卒中相关并发症发生率较低（55.8%对91.4%），卒中急性期抗血小板药物（93.8%对57.1%）和他汀类药物（46.9%对25.7%）的使用更多，但渗透性药物（69.9%对89.3%）、机械通气（1.8%对20.0%）或去骨瓣减压术（1.8%对15.7%）的使用较少。多因素分析确定了以下与良好预后相关的因素：年龄（比值比，OR 0.95，95%置信区间[CI] 0.92 - 0.98，p < 0.001）、基线NIHSS评分（OR 0.90，95% CI 0.84 - 0.96，p = 0.002）、急性期使用他汀类药物（OR 2.49，95% CI 1.10 - 5.65，p = 0.029）、脑水肿（OR 0.05，95% CI 0.01 - 0.21，p < 0.001）和肺炎（OR 0.42，95% CI 0.19 - 0.93，p = 0.032）。
结论
超过三分之一的LHI患者在90天时具有相对良好的临床结局。年龄较小、基线NIHSS评分较低、无脑水肿和肺炎以及急性期使用他汀类药物与LHI患者90天时的良好预后相关。
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