后循环脑梗死诱发全身炎症反应综合征危险因素分析及对预后的影响

摘要

Objective To investigate risk factors and prognosis of systemic inflammatory re⁃sponse syndrome(SIRS)caused by posterior circulation cerebral infarction(PCI). Methods Clinical data of 108 acute PCI patients were analyzed retrospectively. According to diagnosis criteria of SIRS, all patients were divided into two groups: with SIRS group and without SIRS group within the 21 days after onset. The clinic records and laboratory data were analyzed by logistic regression to find potential risk factors of SIRS caused by PCI and contributors of prognosis. Results Forty- nine PCI patients had SIRS within the 21 days after onset. Four factors including history of diabetes, brainstem injury, NIHSS, dysphagia had statistics differences(P<0.05)by univariate analysis. NIHSS(OR=1.132, 95% CI 1.011~1.269, P=0.032), brainstem injury(OR=4.044, 95%CI 1.129~14.494, P=0.032)were the in⁃dependent risk factors for SIRS caused by PCI proved by multivariate analysis. NIHSS(OR=1.552, 95%CI 1.060~2.272, P=0.024)influenced the prognosis of PCI patients with SIRS. Conclusion Risk fac⁃tors associated with SIRS caused by PCI are degree of neurological deficits and injury of brainstem. And degree of neurological deficits affects the prognosis of PCI patients with SIRS.%目的：探讨影响后循环脑梗死诱发全身炎症反应综合征（SIRS）的危险因素及对预后的影响。方法回顾性分析108例后循环脑梗死患者临床资料。根据SIRS的诊断标准，比较发病后21 d内合并SIRS与无SIRS患者之间的差异，对可能影响后循环脑梗死诱发SIRS的若干因素进行多因素回归分析。并进一步通过 Logistic 回归分析影响合并 SIRS 的后循环脑梗死患者预后的危险因素。结果49例后循环脑梗死患者在发病后21 d内出现SIRS。单因素分析显示，糖尿病史、脑干受累、入院时 NIHSS 评分和吞咽困难4个因素有统计学意义（P＜0.05），而多因素分析显示，入院时 NIHSS 评分（OR＝1.132，95%CI 1.011～1.269，P＝0.032）、脑干受累（OR＝4.044，95%CI 1.129～14.494，P＝0.032）为影响后循环脑梗死诱发 SIRS 的独立危险因素。其中入院时NIHSS评分（OR＝1.552，95%CI 1.060～2.272，P＝0.024）是后循环脑梗死合并SIRS预后不良的独立危险因素。结论入院时神经功能缺损程度、病灶是否累及脑干是后循环脑梗死患者发生SIRS的独立危险因素，而神经功能缺损程度影响了合并SIRS后循环脑梗死患者的预后。