目的 分析静脉溶栓治疗首发急性缺血性脑卒中(Acute ischemic stroke,AIS)患者的预后影响因素及预测价值.方法 选择201 9年4月-2022年4月在溧阳市人民医院神经内科进行静脉溶栓治疗的首发AIS患者120例,根据改良Rankin量表(Modified rankin scale,mRS)分为预后良好组(n=61,＜2分)和预后不良组(n=59,≥2分).比较两组临床资料,从中筛选出首发AIS患者应用静脉溶栓治疗的预后危险因素,评估其对首发AIS患者应用静脉溶栓治疗的预测价值.结果 预后不良组既往存在糖尿病史、大动脉粥样硬化分型占比大于预后良好组,发病至溶栓开始时间滞后于预后良好组,入院时美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分及血糖、纤维蛋白原水平高于预后良好组(P＜0.05).多因素Logistic回归分析发现,存在糖尿病史、发病至溶栓开始时间长、入院时NIHSS评分高、大动脉粥样硬化分型、高血糖、高纤维蛋白原为首发AIS患者应用静脉溶栓治疗后预后不良的独立危险因素(OR=4.627、4.831、5.124、5.043、4.669、4.821,P＜0.05).首发AIS患者应用静脉溶栓治疗后预后不良的曲线下面积(Area under curve,AUC)为0.812(95％CI:0.753～0.834),敏感度为0.67,特异度为0.86.结论 既往存在糖尿病史、发病至溶栓开始时间长、入院时NIHSS评分高、大动脉粥样硬化分型、高血糖、高纤维蛋白原对预测首发AIS患者具有较高的敏感性和特异性.
Prognostic factors and predictive value of intravenous thrombolysis in patients with first-episode acute ischemic stroke
Objective To analyze the prognostic factors and predictive value of intravenous thrombolysis for first-episode acute ischemic stroke(AIS)patients.Methods 120 first-time AIS patients who underwent intravenous thrombolysis treatment in the hospital from April 2019 to April 2022 were selected.According to the modified Rankin scale(mRS),thepatients were divided into good prognosis group(n=61,＜2 points)and a poor prognosis group(n=59,≥ 2 points).Compare 2 sets of clinical data to identify risk factors for poor prognosis in first-episode AIS patients after intravenous thrombolysis treatment,and eval-uate their predictive value for AIS patients after intravenous thrombolysis treatment.Results The poor prognosis group had a history of diabetes and a larger proportion of major atherosclerosis types than the good prognosis group,and the time from onset to the beginning of thrombolysis lagged behind the good prognosis group.At admission,National Institute of Health Stroke Scale(NIHSS)score andblood glucose and fibrinogen levels were higher than the good prognosis group(P＜0.05).Multivariate logistic regres-sion analysis found that the history of diabetes,the long time from onset to the beginning of thrombolysis,the high NIHSS score at admission,the classification of large atherosclerosis,hyperglycemia and hyperfi-brinogen were the risk factors for poor prognosis of the first AIS patients after intravenous thrombolysis(OR=4.627,4.831,5.124,5.043,4.669,4.821,P＜0.05).The area under curve(AUC)for predic-ting poor prognosis in first-episode AIS patients after intravenous thrombolysis treatment was 0.812(95％CI:0.753-0.834),with a sensitivity of 0.67and a specificity of 0.86.Conclusion The history of diabe-tes,the long time from onset to the beginning of thrombolysis,the high NIHSS score at admission,the classification of large atherosclerosis,hyperglycemia and hyperfibrinogen are independent risk factors which have high sensitivity and specificity in predicting first episode AIS patients.
first roundacute ischemic stroke(AIS)intravenous thrombolysisprognosisinfluencing factors
万方数据
维普
