目的:探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者接受院前远隔缺血适应(remote is-chemic conditioning,RIC)联合院内溶栓治疗后近期神经功能预后的影响因素.方法:回顾性选择2020年1月-2023年1月我院行院前RIC+院内溶栓的127例AIS患者为观察组,将同期在我院行溶栓而未进行RIC治疗的AIS患者50例纳至对照组,比较分析两组治疗效果与预后情况.根据127例AIS患者近期神经功能预后情况,将其分为良好结局组与不良结局组,比较两组临床资料及实验室指标,分析AIS近期神经功能预后的危险因素,分析各因素/指标与AIS近期神经功能预后的相关性,评价各因素/指标对AIS近期神经功能预后的预测效能.结果:观察组治疗总有效率显著高于对照组,差异有统计学意义(P＜0.05);不良结局率显著低于对照组,差异有统计学意义(P＜0.05).与良好结局组比较,不良结局组年龄、糖尿病史占比、冠心病史占比、入院时美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分、溶栓 24 h 后 NIHSS 评分、脑钠肽(brain natri-uretic peptide,BNP)、C-反应蛋白(C-reactive protein,CRP)、D-二聚体(D-Dimer)、胱抑素 C(Cystatin C,CysC)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、脑梗死体积明显升高,差异有统计学意义(P＜0.05).logistic回归模型显示,入院时NIHSS评分、溶栓24 h后NIHSS评分、BNP、CRP、D-Dimer、Cys C、NLR、PLR、脑梗死体积为AIS患者近期神经功能预后的危险因素(P＜0.05).Spearman检验提示,AIS患者近期神经功能预后与入院时NIHSS评分、溶栓24 h后NIHSS评分、BNP、CRP、D-Dimer、Cys C、NLR、PLR、脑梗死体积呈正相关(P＜0.05).绘制ROC曲线发现,9个因素(入院时NIHSS评分、溶栓24 h后NIHSS评分、BNP、CRP、D-Dimer、Cys C、NLR、PLR、脑梗死体积)联合预测AIS近期神经功能预后的AUC值、灵敏度、特异度为0.948、80.50、94.23,其效能明显优于单一指标,差异有统计学意义(P＜0.05).结论:入院时NIHSS评分、溶栓24 h后NIHSS评分、脑梗死体积、BNP、CRP、D-Dimer、Cys C、NLR、PLR升高为AIS患者近期神经功能预后的危险因素,并对预后不良有较好的预测价值.
Analysis of influencing factors on the recent neurological prognosis of AIS patients receiving pre-hospital RIC combined with intra hospital thrombolysis therapy
Objective:To explore the influencing factors of recent neurological prognosis in patients with acute ischemic stroke(AIS)after receiving pre hospital remote ischemic adaptation(RIC)combined with intra hospital thrombolysis therapy.Methods:Retrospectively selection of 127 AIS patients who underwent pre-hospital RIC and intra-hospital thrombolysis in our hospital from January 2020 to January 2023 were retrospectively selected as the observation group,50 AIS patients who underwent thrombolysis in our hospital during the same period but did not receive RIC treatment were selected as the control group.The treatment efficacy and prognosis of the two groups were compared and analyzed.Based on the recent neurological prognosis of 127 AIS patients,they were divided in-to a good outcome group and adverse outcome group.Clinical data and laboratory indicators were compared be-tween the two groups,and the risk factors for recent neurological prognosis of AIS were analyzed.The correlation between each factor/indicator and recent neurological prognosis of AIS was analyzed,and the predictive efficacy of each factor/indicator on recent neurological prognosis of AIS was evaluated.Results:The total effective rate of the observation group was significantly higher than that of the control group(P＜0.05),and the adverse outcome rate was significantly lower than that of the control group(P＜0.05).Compared with the good outcome group,the age,the proportion of diabetes history,the proportion of coronary heart disease history,the national institute of health stroke scale(NIHSS)score at admission,the NIHSS score 24 hours after thrombolysis,brain natriuretic peptide(BNP),C-reactive protein(CRP),D-Dimer,cystatin C(Cys C),neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),and cerebral infarction volume in the adverse outcome group increased signifi-cantly(P＜0.05).The logistic regression model showed that NIHSS score at admission,NIHSS score 24 hours after thrombolysis,BNP,CRP,D-Dimer,Cys C,NLR,PLR,and cerebral infarction volume were risk factors for the recent neurological prognosis of AIS patients(P＜0.05).Spearman test showed that the recent neurologi-cal prognosis of AIS patients was positively correlated with NIHSS score at admission,NIHSS score 24 hours af-ter thrombolysis,BNP,CRP,D-Dimer,Cys C,NLR,PLR and cerebral infarction volume(P＜0.05).Drawing the ROC curve,it was found that the AUC value,sensitivity and specificity of combining nine factors(NIHSS score at admission,NIHSS score 24 hours after thrombolysis,BNP,CRP,D-Dimer,Cys C,NLR,PLR,and cerebral infarction volume)for predicting the recent neurological prognosis in AIS were 0.948,80.50 and 94.23,respectively.And their efficacy was significantly better than any single indicator(P＜0.05).Conclusion:The NIHSS score at admission,the NIHSS score 24 hours after thrombolysis,cerebral infarction volume,BNP,CRP,D-Dimer,Cys C,NLR,and PLR elevation are risk factors for the recent neurological prognosis of AIS pa-tients,and have good predictive value for poor prognosis.
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