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急性脑梗死患者微栓子信号的影响因素 及其与近期预后的关系研究
李忠飞岑斯邵枝定徐阳
0
()
摘要:
目的 探讨急性脑梗死患者微栓子信号的影响因素及其与近期预后的关系。方法 前瞻 性连续纳入2019 年1 月至2020 年1 月皖南医学院第二附属医院神经内科接诊的118 例急性脑梗死患者 作为研究对象,均经颅多普勒监测微栓子信号,根据微栓子信号是否阳性,分为阳性组和阴性组。采用单因 素和多因素Logistic回归分析微栓子信号的影响因素;随访6个月,观察脑梗死复发情况,通过Kaplan-Meier 生存曲线分析微栓子信号阳性与脑梗死复发的关系。结果 118例急性脑梗死患者中,36 例(30.51%)微 栓子信号阳性;阳性组有颈动脉斑块占比[69.44%(25/36)]、颈动脉重度狭窄率[55.56%(20/36)]、血小 板[(278.84±26.93)×109/L]、超敏C 反应蛋白水平[(13.87±3.58)mg/L]、美国国立卫生研究院卒中量 表(NIHSS)评分[(5.93±1.17)分]均明显高于阴性组,高密度脂蛋白胆固醇水平[(0.91±0.33)mmol/L] 低于阴性组[分别为29.27%(24/82)、20.73%(17/82)、(215.48±16.53)×109/L、(9.87±2.07)mg/L、(4.88± 0.58)分、(1.23±0.65)mmol/L],差异均有统计学意义(均P < 0.05)。经多因素Logistic 回归分析,颈动 脉斑块(OR=7.425,95%CI:2.892~28.882)、重度狭窄(OR=2.692,95%CI:1.362~8.736)、高水平血小板 (OR=8.462,95%CI:1.425~16.465)均是微栓子信号阳性的独立危险因素(均P< 0.05)。 所有患者获得 随访,脑梗死复发15 例,其中阳性组脑梗死复发率为22.22%(8/36),高于阴性组的8.54%(7/82),差异有 统计学意义(χ2=4.223,P=0.040);经Kaplan-Meier 生存曲线分析和Log-rank 检验,阳性组较阴性组患者 更易出现脑梗死复发(P< 0.05)。结论 急性脑梗死患者微栓子信号阳性与颈动脉斑块、重度狭窄和高 水平血小板有关,提示这部分患者近期预后更差,需要更加密切的随访,严格控制危险因素。
关键词:  Cerebral infarction  Microembolic signal  Influencing factors  Recent prognosis  Recurrence
DOI:10.3969/j.issn.1009-6574.2020.11.003
基金项目:国家自然科学基金青年科学基金项目(81701161)
Study on the influencing factors of microembolic signal in patients with acute cerebral infarction andits relationship with short-term prognosis
Li Zhongfei, Cen Si, Shao Zhiding, Xu Yang
()
Abstract:
Objective To explore the influencing factors of microembolic signal in patients with acute cerebral infarction and its relationship with short-term prognosis. Methods A total of 118 patients with acute cerebral infarction admitted to the Neurology Department of the Second Affiliated Hospital of Wannan Medical College from January 2019 to January 2020 were prospectively enrolled as the research objects. All of them were monitored by transcranial Doppler for microembolic signals. According to whether the microembolic signals were positive, they were were divided into positive group and negative group. Uni-variate and multivariate logistic regression were used to analyze the influencing factors of microembolic signal; After 6 months of follow-up, the recurrence of cerebral infarction was observed. The relationship between the positive microembolic signal and the recurrence of cerebral infarction was analyzed by Kaplan-Meier survival curve. Rusults There were 36 of the 118( 30.51%) patients with acute cerebral infarction had positive microembolic signals. Carotid artery plaque [69.44%( 25/36)], severe stenosis rate of carotid artery[ 55.56%( 20/36)], platelet( PLT)[ (278.84±26.93)×109/L], high sensitivity C-reactive protein( hs-CRP) level[ (13.87±3.58) mg/L], and the National Institutes of Health Stroke Scale( NIHSS) score( 5.93±1.17) in the positive group were significantly higher than those in the negative group[ 29.27%( 24/82), 20.73%( 17/82),( 215.48±16.53)×109/L,( 9.87±2.07) mg/L, (4.88±0.58)]; high-density lipoprotein cholesterol( HDL-C) level in the positive group[ (0.91±0.33) mmol /L] was lower than that of the negative group[ (1.23±0.65) mmol/L]. The differences were statistically significant (all P<0.05). According to multivariate logistic regression analysis results, carotid artery plaque( OR=7.425, 95%CI: 2.892-28.882), severe stenosis( OR=2.692, 95%CI:1.362-8.736), and high PLT level( OR=8.462, 95%CI:1.425-16.465) were all independent risk factors of positive microembolic signals( all P < 0.05). All patients were followed up, and 15 cases of cerebral infarction recurred, of which the positive group was 22.22% (8/36), higher than 8.54%( 7/82) of the negative group. The difference was statistically significant( χ2=4.223, P=0.040). Kaplan-Meier survival curve analysis and Log-rank test showed that patients in positive group were more likely to have cerebral infarction recurrence than those in negative group( P<0.05). Conclusions The positive microembolic signals in patients with acute cerebral infarction are related to carotid plaque, severe stenosis and high level of platelets, suggesting that these patients have a worse short-term prognosis and require closer follow-up to strictly control risk factors.
Key words:  脑梗死  微栓子信号  影响因素  近期预后  复发

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