入院时血尿素水平与溶栓治疗的老年急性缺血性脑卒中患者短期临床预后的关系

摘要

目的 探讨入院时血尿素水平与溶栓治疗的老年急性缺血性脑卒中患者短期临床预后的关系.方法 回顾性收集在我院接受重组组织型纤溶酶原激活剂静脉溶栓治疗的老年急性缺血性脑卒中患者192例.在溶栓治疗后(90±3)d应用改良的Rankin量表(mRS)评分进行神经功能预后评定,mRS评分0～2分为临床预后良好,mRS评分3～6分为临床预后不良.采用logistic回归分析计算血尿素水平与临床预后不良的关系.结果 单因素logistic回归分析显示:心房颤动、血尿素、美国国立卫生研究院卒中量表(NIHSS)评分与不良临床预后相关;小动脉闭塞性脑卒中和原因不明缺血性脑卒中发生不良预后的风险相对较低.多因素logistic回归分析显示:血尿素(OR=1.309,95％CI:1.080～1.587,P=0.006)、NIHSS评分(OR=1.321,95％CI:1.205～1.447,P=0.000)、心房颤动(OR=3.782,95％CI:1.384～10.335,P=0.010)是不良临床预后的独立危险因素.结论 入院时血尿素水平是溶栓治疗的老年急性缺血性脑卒中患者90 d不良临床预后的独立危险因素.%Objective To study the relationship between blood urea nitrogen (BUN) level on admission and short-term clinical outcome in elderly acute ischemic stroke (AIS) patients after thrombolytic therapy.Methods One hundred and ninety-two AIS patients admitted to our hospital from May 2014 to January 2016 for thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) were included in this study.Their clinical outcome was scored according to the mRS and considered as poor when the mRS score was 3-6 after 90 days of thrombolytic therapy.Relationship between BUN level and poor clinical outcome was analyzed by logistic regression analysis.Results Univariate logistic regression analysis showed that AF,BUN level and NIHSS score were related with poor clinical outcome in AIS patients.The risk of poor clinical outcome was relatively low in ischemic stroke due to small artery occlusion or unknown reasons (OR =0.106,95％CI:0.023-0.481,P=0.004;OR=0.378,95％CI:0.177-0.811,P=0.012).Mltivariate logistic regression analysis showed that BUN level,NIHSS score and AF were the independent risk factors for poor clinical outcome in AIS patients (OR=1.309,95 ％CI:1.080-1.587,P=0.006;OR=1.321,95％CI:1.205-1.447,P=0.000;OR=3.782,95％ CI:1.384-10.335,P=0.010).Conclusion The BUN level on admission is an independent risk factor for poor clinical outcome in elderly AIS patients after 90 days of thrombolytic therapy.