急性缺血性脑卒中部分危险因素聚集对患者发生复合结局的影响研究

摘要

Objective To study the influence of the aggregation of partial risk factors for acute ischemic stroke on the occurrence of composite outcome in patients. Methods We enrolled 3 151 patients With acute ischemic stroke Who Were admitted into the Department of Neurology of Fuxin Central Hospital from June,2009 to May,2012. Demographic data and the results of physical examination,laboratory examination and imageological diagnosis Were collected. Modified Rankin's scale ( mRS ) of stoke Was employed on the subjects at discharge from hospital. According to mRS,the subjects Were divided into three groups:control group(0≤mRS≤2;n=2 640),disability group(3≤mRS≤5;n=407),death group(mRS=6;n=104)and composite outcome group of disability and death(3≤mRS≤6;n=511). The Cox regression analysis Was conducted to examine the influence of the aggregation of partial risk factors for acute ischemic stroke on the occurrence of composite outcome in patients. Results Control group,disability group,death group Were significantly different(P <0. 05)in age,temperature, systolic pressure,diastolic pressure,loW density lipoprotein cholesterin,creatinine,urea nitrogen,fibrinogen level,relapse of stroke,dyslipidemia,abnormal renal function,increase in White blood cells,decrease in albumin,hyperglycemia and increase in fibrinogen. The single-factor and multi-factor Cox regression analyses shoWed that increase in White blood cells,decrease in albumin,hyperglycemia and increase in fibrinogen had significant influence(P<0. 05)on the occurrence of composite outcome in patients With acute ischemic stroke at discharge from hospital. It also shoWed that,among the four risk factors,conditions Where one,tWo,three or four existed all had significant influence on the occurrence composite outcome in patients With acute ischemic stroke at discharge from hospital,and With the increase of risk factors,the risk in the occurrence of composite outcome in patients With acute ischemic stroke at discharge from hospital increased significantly ( P <0. 05 ) . Conclusion With the increase of the number of risk factors among increase in White blood cells,decrease in albumin,hyperglycemia and increase in fibrinogen,the risk in the occurrence of composite outcome in patients With acute ischemic stroke at discharge from hospital increases significantly.%目的：探讨急性缺血性脑卒中部分危险因素聚集对患者发生复合结局的影响。方法连续性纳入2009年6月—2012年5月在辽宁省阜新市中心医院神经内科住院的所有急性缺血性脑卒中患者共3151例，收集其人口学、体格检查、实验室检查、影像学检查结果等相关资料。患者出院时采用Modified Rankin＇s scale（ mRS）脑卒中量表进行评分，以0分≤mRS≤2分为对照组（2640例），3分≤mRS≤5分为残疾组（407例），mRS=6分为死亡组（104例），3分≤mRS≤6分为残疾和死亡复合结局组（511例）。采用Cox回归分析急性缺血性脑卒中部分危险因素聚集对患者发生复合结局的影响。结果对照组、残疾组、死亡组急性缺血性脑卒中患者在年龄，体温、收缩压、舒张压、低密度脂蛋白胆固醇、肌酐、尿素氮、纤维蛋白原水平，卒中复发、血脂异常、肾功能异常、白细胞升高、清蛋白降低、高血糖、纤维蛋白原增高发生率方面差异均有统计学意义（ P<0.05）。单因素和多因素Cox回归分析均显示，白细胞升高、清蛋白降低、高血糖及纤维蛋白原增高对急性缺血性脑卒中患者出院发生复合结局的影响有统计学意义（ P<0.05）。单因素和多因素Cox回归分析结果显示，白细胞升高、清蛋白降低、高血糖及纤维蛋白原增高4项危险因素的个数为1个、2个、3个、4个时，对急性缺血性脑卒中患者出院发生复合结局的影响均有统计学意义（P <0.05）；且随着危险因素聚集个数的增多，急性缺血性脑卒中患者出院发生复合结局的危险增大，有统计学意义（ P<0.05）。结论随着白细胞升高、清蛋白降低、高血糖及纤维蛋白原增高危险因素聚集个数的增多，急性缺血性脑卒中患者出院发生复合结局的危险性就更大。