中华急诊医学杂志2024,Vol.33Issue(10) :1421-1426.DOI:10.3760/cma.j.issn.1671-0282.2024.10.012

早期核心梗死增长速率预测大血管闭塞性急性缺血性脑卒中患者预后的价值

The value of EIGR in predicting prognosis of patients with acute ischemic stroke with large vessel occlusion

李晓慧 汪璇 许晓泉 李华 季荔 茆丽娜 万芬 王瑶 姜丽丽 陈旭锋 蒋雷
中华急诊医学杂志2024,Vol.33Issue(10) :1421-1426.DOI:10.3760/cma.j.issn.1671-0282.2024.10.012

早期核心梗死增长速率预测大血管闭塞性急性缺血性脑卒中患者预后的价值

The value of EIGR in predicting prognosis of patients with acute ischemic stroke with large vessel occlusion

李晓慧 1汪璇 2许晓泉 3李华 1季荔 1茆丽娜 1万芬 1王瑶 1姜丽丽 1陈旭锋 1蒋雷1
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作者信息

  • 1. 南京医科大学第一附属医院急诊科,南京 210029
  • 2. 南京医科大学公共卫生学院,南京 211166
  • 3. 南京医科大学第一附属医院放射科,南京 210029
  • 折叠

摘要

目的 探讨早期核心梗死增长速率(early infarct growth rate,EIGR)对急性大血管闭塞性缺血性脑卒中患者临床预后的影响.方法 选取2020年1月1日至2022年12月31日于南京医科大学第一附属医院急诊科就诊的急性大血管闭塞性缺血性脑卒中患者164例.根据就诊时和治疗后72 h美国国立卫生研究院卒中量表(NIHSS)评分改变值分为预后良好组和预后不佳组,观察并比较两组患者基本临床资料,采用单因素回归分析预后不佳的危险因素.并深入分析年龄分层后核心梗死增长速率对预后的影响.结果 对比两组临床资料发现,两组核心梗死增长速率(mL/h)(7.67 vs.8.24,P=0.211)差异无统计学意义.纳入核心梗死增长速率和年龄之间的乘积作为交互项,模型中交互项的结果有统计学意义(OR=1.002,95%CI:1.000~1.003,P=0.032),并且在校正了相关变量后(性别、高血压史、房颤史、糖尿病史、冠心病史、脑卒中史)结果仍有统计学意义(OR=1.002,95%CI:1.000~1.003,P=0.027).对年龄按照中位数(71岁)进行亚组分析,高龄组中,依据25 mL/h和15 mL/h界定的快速型核心梗死增长速率的不良预后占比更高(P<0.05),低龄组中,快速型核心梗死增长速率的不良预后比例较缓慢型差异无统计学意义(P>0.05).结论 核心梗死增长速率在老年大血管闭塞性缺血性脑卒中患者中可早期预测临床预后.

Abstract

Objective To investigate the effect of Early infarct growth rate(EIGR)on the prognosis of patients with acute large vessel occlusive ischemic stroke.Methods A total of 164 patients with acute large vessel occlusive ischemic stroke were enrolled in the emergency department of the First Affiliated Hospital of Nanjing Medical University from January 1,2020 to December 31,2022.According to the change of the National Institutes of Health Stroke Scale(NIHSS)score at admission and 72 h after treatment,the patients were divided into good prognosis group and poor prognosis group.The basic clinical data of the two groups were observed and compared.The risk factors of poor prognosis were analyzed by univariate regression.The effect of EIGR on prognosis after age stratification was further analyzed.Results Comparing the clinical data of the two groups,there was no difference in EIGR(mL/h)(7.67 vs.8.24,P=0.211)between the two groups.The product between EIGR and age was included as the interaction term,and the result of the interaction term in the model was statistically significant(OR=1.002,95%CI:1.000-1.003,P=0.032).Moreover,the result was still statistically significant after adjusting for relevant variables(gender,history of hypertension,history of atrial fibrillation,history of diabetes,history of coronary heart disease,and history of stroke)(OR=1.002,95%CI:1.000-1.003,P=0.027).Subgroup analysis was performed according to the median age(71 years).In the elderly group,the proportion of poor prognosis was higher with fast core infarction growth rate defined by 25 mL/h and 15 mL/h(P<0.05).In the younger age group,there was no significant difference in the proportion of poor prognosis in the fast core infarction growth rate compared with the slow type(P>0.05).Conclusions EIGR can predict the early clinical outcome early in elderly patients with large vessel occlusive ischemic stroke.

关键词

急性缺血性脑卒中/早期核心梗死增长速率/大血管闭塞/预后

Key words

Acute ischemic stroke/Early infarct growth rate/Large vessel occlusion/prognosis

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基金项目

江苏省"六大人才高峰"资助项目(WSN-005)

江苏省财政支持临床重点专科(YWC-ZKJS-2020-03)

江苏省管医院专科建设项目(YWC-ZKJS-2021-01)

临床能力提升工程(JSPH-MC-2021-5)

出版年

2024
中华急诊医学杂志
中华医学会

中华急诊医学杂志

CSTPCDCSCD北大核心
影响因子:1.556
ISSN:1671-0282
参考文献量17
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