缺血性脑卒中患者合并不宁腿综合征的特点和临床意义

目的: 研究缺血性脑卒中患者不宁腿综合征（RLS）的患病率、危险因素、临床特点以及对缺血性脑卒中的影响。方法: 收集2016年1月至2018年6月在浙江大学医学院附属邵逸夫医院神经内科住院的缺血性脑卒中患者199例。所有患者接受了多导睡眠监测。RLS采用国际RLS研究组制订的标准确诊。收集患者住院期间的临床资料进行危险因素分析。用Epworth嗜睡量表（ESS）评估患者的睡眠质量，简易智力状态检查评估患者的认知功能，患者的健康问卷（PHQ-9）评估患者的抑郁症状，采用美国国立卫生院卒中量表（NIHSS）评估患者的神经功能。选取年龄和性别匹配的原发性RLS患者，评估缺血性脑卒中合并RLS患者的多导睡眠监测特征。结果: 199例缺血性脑卒中患者中有22例存在RLS（11.1%）。广义线性模型和Logistic回归分析提示血清铁蛋白水平下降（β=-133.3 mg/L，95%CI：-200.4~-70.1，P < 0.01），皮层下梗死（OR=4.05，95%CI：1.15~14.18，P < 0.05）和女性（OR=2.54，95%CI：1.04~6.23，P < 0.05）是缺血性脑卒中合并RLS的危险因素。与不合并RLS的缺血性脑卒中患者比较，合并RLS的缺血性脑卒中患者ESS值升高4.37分（95%CI：2.33~6.41，P < 0.01），PHQ-9分值增加2.17分（95%CI：0.39~3.94，P < 0.05），中重度抑郁风险增加4.27倍（95%CI：1.40~13.10，P < 0.05），NIHSS减分值减少0.97分（95%CI：-1.79~-0.15，P < 0.05）。与原发性RLS患者相比，合并缺血性脑卒中的RLS患者伴微觉醒的周期性腿动指数增加（β=12.85，95%CI：2.04~23.67，P < 0.05）。结论: RLS在缺血性脑卒中患者中较常见，且对缺血性脑卒中患者造成不利影响，应重视筛查和治疗。

Restless legs syndrome in ischemic stroke patients: clinical features and significance

Objective: To investigate the clinical features and implication of restless legs syndrome (RLS) in ischemic stroke patients. Methods: A total of 199 ischemic stroke patients were enrolled and assessed by polysomnography (PSG). RLS was identified according to criteria of International Restless Legs Syndrome Study Group. Epworth Sleepiness Scale (ESS), Mini-mental State Examination (MMSE) and Patient Health Questionnaire (PHQ-9) were used to evaluate the sleep quality, cognitive function and post-stroke depression, respectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the neurological function 3 months after stroke onset. Gender-and age-matched non-ischemic stroke patients with RLS (primary PLS) were selected as controls. Results: Twenty-two cases of RLS were identified among 199 ischemic stroke patients (11.1%). Generalized linear model and logistic regression showed that low serum ferritin level (β=-133.3 mg/L, 95%CI:-200.4--0.1, P < 0.01), subcortical infarction (OR=4.05, 95%CI:1.15-14.18, P < 0.05) and female (OR=2.54, 95%CI:1.04-6.23, P < 0.05) were identified as the risk factors of RLS in ischemic stroke patients. Compared with ischemic stroke patients without RLS, ESS increased by 4.37 (95%CI:2.33-6.41, P < 0.01), PHQ-9 increased by 2.17 (95%CI:0.39--3.94, P < 0.05), and reduced NIHSS from the baseline deceased by 0.97 (95%CI:-1.79--0.15, P < 0.05) in ischemic stroke patients with RLS. In addition, the incidence of moderate-severe depression increased (OR=4.27, 95%CI:1.40-13.10, P < 0.05) in ischemic stroke patients with RLS. The index of periodic leg movements of sleep (PLMS) with arousal in ischemic stroke patients with RLS was significantly higher than that in patients with primary RLS (β=12.85, 95%CI:2.04-23.67, P < 0.05). Conclusion: RLS is common in ischemic stroke patients and has adverse influences on patients.