Reith J, Jørgensen H S, Pedersen P M, Nakayama H, Raaschou H O, Jeppesen L L, Olsen T S
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Lancet. 1996 Feb 17;347(8999):422-5. doi: 10.1016/s0140-6736(96)90008-2.
In laboratory animals, cerebral ischaemia is worsened by hyperthermia and improved by hypothermia. Whether these observations apply to human beings with stroke is unknown. We therefore examined the relation between body temperature on admission with acute stroke and various indices of stroke severity and outcome.
In a prospective and consecutive study 390 stroke patients were admitted to hospital within 6 h after stroke (median 2.4 h). We determined body temperature on admission, initial stroke severity, infarct size, mortality, and outcome in survivors. Stroke severity was measured on admission, weekly, and at discharge on the Scandinavian Stroke Scale (SSS). Infarct size was determined by computed tomography. Multiple logistic and linear regression outcome analyses included relevant confounders and potential predictors such as age, gender, stroke severity on admission, body temperature, infections, leucocytosis, diabetes, hypertension, atrial fibrillation, ischaemic heart disease, smoking previous stroke, and comorbidity.
Mortality was lower and outcome better in patients with mild hypothermia on admission; both were worse in patients with hyperthermia. Body temperature was independently related to initial stroke severity (p < 0.009), infarct size (p < 0.0001), mortality (p < 0.02), and outcome in survivors (SSS at discharge) (p < 0.003). For each 1 degrees C increase in body temperature the relative risk of poor outcome (death or SSS score on discharge < 30 points) rose by 2.2 (95% CI 1.4-3.5) (p < 0.002).
We have shown that, in acute human stroke, an association exists between body temperature and initial stroke severity, infarct size, mortality, and outcome. Only intervention trials of hypothermic treatment can prove whether this relation is causal.
在实验动物中，体温过高会加重脑缺血，而体温过低则可改善脑缺血。这些观察结果是否适用于中风患者尚不清楚。因此，我们研究了急性中风患者入院时的体温与中风严重程度及预后的各项指标之间的关系。
在一项前瞻性连续研究中，390例中风患者在中风后6小时内（中位数为2.4小时）入院。我们测定了患者入院时的体温、初始中风严重程度、梗死面积、死亡率以及幸存者的预后情况。中风严重程度在入院时、每周以及出院时采用斯堪的纳维亚中风量表（SSS）进行测量。梗死面积通过计算机断层扫描确定。多因素逻辑回归和线性回归结果分析纳入了相关混杂因素和潜在预测因素，如年龄、性别、入院时的中风严重程度、体温、感染、白细胞增多、糖尿病、高血压、心房颤动、缺血性心脏病、吸烟史、既往中风史以及合并症。
入院时体温轻度过低的患者死亡率较低，预后较好；体温过高的患者则相反。体温与初始中风严重程度（p < 0.009）、梗死面积（p < 0.0001）、死亡率（p < 0.02）以及幸存者的预后情况（出院时的SSS评分）（p < 0.003）独立相关。体温每升高1摄氏度，不良预后（死亡或出院时SSS评分< 30分）的相对风险增加2.2（95%可信区间1.4 - 3.5）（p < 0.002）。
我们已经表明，在急性人类中风中，体温与初始中风严重程度、梗死面积、死亡率和预后之间存在关联。只有低温治疗的干预试验才能证明这种关系是否具有因果性。
