伴周期性肢体运动急性脑梗死患者的临床特征初步分析

目的初步分析伴睡眠中周期性肢体运动(PLMS)的急性脑梗死患者的临床特征。方法连续纳入2016年2月至2018年6月苏州大学附属第二医院神经内科急性脑梗死住院患者170例进行前瞻性分析,其中男102例(60.0%),女68例(40.0%)。根据周期性肢体运动指数(PLMI),将170例急性脑梗死患者分为无PLMS组(PLMI<5次/h)和PLMS组(PLMI≥5次/h)。在脑梗死发病14 d内行体动记录仪监测和头部MR检查。记录两组患者基线美国国立卫生研究院卒中量表(NIHSS)评分、既往病史(包括高血压病、糖尿病、心房颤动、冠心病、高脂血症)、吸烟史、脑梗死分型牛津郡社区卒中计划(OCSP)卒中分型]、生化指标(糖化血红蛋白、肌酐、同型半胱氨酸、总胆固醇、低密度脂蛋白)、睡眠参数,并进行组间比较。应用改良Rankin量表(mRS)评分评估脑梗死患者发病3、6、12个月的神经功能恢复情况,应用Barthel指数评估急性脑梗死患者发病12个月的日常生活自理能力,并进行组间比较。以PLMI≥5次/h定义为PLMS。结果 (1)急性脑梗死患者中合并PLMS的比例为61.2%(104/170)。无PLMS组既往卒中史比例低于PLMS组,组间差异有统计学意义24.2%(16/66)比39.4%(41/104),χ~2=3.866,P=0.049];年龄、性别、吸烟史、高血压病、糖尿病、心房颤动、NIHSS评分的组间差异均无统计学意义(均P>0.05)。(2)无PLMS组中,部分前循环梗死比例最高(34.8%,23/66),完全前循环梗死比例最低(10.6%,7/66);PLMS组中,腔隙性梗死比例最高(36.5%,38/104),完全前循环梗死比例最低(8.7%,9/104)。两组OCSP卒中分型的差异有统计学意义(χ~2=12.528,P=0.006),两组空腹血糖、糖化血红蛋白、肌酐、同型半胱氨酸、总胆固醇、低密度脂蛋白水平的差异均无统计学意义(均P>0.05)。(3)无PLMS组觉醒比例、觉醒时间、觉醒次数均低于PLMS组,组间差异均有统计学意义6.0(3.0,8.0)比12.0(7.0,19.0)、3.0(1.5,4.2) min比4.4(3.0,6.0) min、18.5(7.0,33.8)次比50.0(28.0,84.0)次,Z值分别为-6.046、-3.922、-6.789,均P<0.01],睡眠效率、总睡眠时间高于PLMS组,组间差异均有统计学意义96.6%(93.6%,98.7%)比91.0%(84.6%,93.9%)、497.0(470.0,529.8) min比489.0(447.0,507.0) min,Z值分别为-6.586、-2.503,均P<0.01]。(4)无PLMS组与PLMS组患者发病3、6、12个月预后良好率的差异均无统计学意义(均P>0.05);发病12个月时,两组Barthel指数的差异无统计学意义(P>0.05)。结论急性脑梗死患者急性期PLMS的比例高,合并PLMS的急性脑梗死患者腔隙性梗死的比例较高,同时存在睡眠片段化。

Preliminary clinical analysis for acute cerebral infarction with periodic limb movements

Objective To analyze the clinical features of patients with acute cerebral infarction combined with periodic limb movements during sleep(PLMS). Methods A total of 170 continuous patients with acute cerebral infarction in the Department of Neurology of the Second Affiliated Hospital of Soochow University from February 2016 to June 2018 was enrolled prospectively, including 102 males(60.0%) and 68 females(40.0%). Those patients were divided into non-PLMS group(period limb movement indexPLMI]<5 times/hour) and PLMS group(PLMI≥5 times/hour) according to the PLMI. Physical activity recorder monitoring and head magnetic resonance imaging were performed within 2 weeks of onset. The baseline National Institutes of Health Stroke Scale(NIHSS) scores, previous medical history(including hypertension, diabetes, atrial fibrillation, coronary heart disease, hyperlipidemia), smoking history, stroke classification of the Oxfordshire Community Stroke Project(OCSP), biochemistry indicators(glycated hemoglobin, creatinine, homocysteine, total cholesterol, low-density lipoprotein), and sleep parameters were recorded and compared between both groups. The modified Rankin Scale(mRS) score was used to evaluate the recovery of neurological function at 3, 6, and 12 months, and the Barthel index was used to assess the self-care ability of daily life at 12 months. PLMI ≥5 times/h was defined as PLMS. Results(1)The proportion of patients with acute cerebral infarction combined with PLMS was 61.2%(104/170). The proportion of previous stroke history in the non-PLMS group was lower than that in the PLMS group, which was statistically significant(24.2%16/66] vs. 39.4% 41/104], χ~2=3.866, P=0.049). There were insignificant in age, gender, smoking history, hypertension, diabetes, atrial fibrillation and NIHSS scores between two groups(all P>0.05).(2) In the non-PLMS group, the proportion of partial anterior circulation infarction was the highest(34.8%, 23/66), and the proportion of complete anterior circulation infarction was the lowest(10.6%, 7/66). In the PLMS group, the proportion of lacunar infarction was the highest(36.5 %, 38/104), and the proportion of complete anterior circulation infarction was the lowest(8.7%, 9/104). There was statistically significant in stroke classification of OCSP between the two groups(χ~2=12.528, P=0.006), but insignificant in fasting blood glucose, glycated hemoglobin, creatinine, homocysteine, total cholesterol and low-density lipoprotein levels between the two groups(both P> 0.05).(3) The proportion of awakening, awakening time, and the number of awakenings in the non-PLMS group were all lower than those in the PLMS group, which were statistically significant(6.03.0, 8.0] vs.12.07.0, 19.0], 3.01.5, 4.2] min vs. 4.43.0, 6.0] min and 18.57.0, 33.8] times vs.50.028.0, 84.0] times, the Z values were-6.046,-3.922 and-6.8789, all P<0.01). Sleep efficiency and total sleep time were higher in the non-PLMS group than those in PLMS group, which were statistically significant(96.6%93.6%, 98.7%] vs.91.0% 84.6%, 93.9%], 497.0470.0, 529.8]min vs. 489.0447.0, 507.0]min, and the Z values were-6.586 and-2.503 respectively, all P<0.01).(4) There was insignificant in the rate of good prognosis at 3, 6, and 12 months, and Barthel index at 12 months after onset between both groups(all P>0.05). Conclusions Patients with acute cerebral infarction have a high proportion of PLMS in the acute phase. There is a high proportion of lacunar infarction and sleep fragmentation in patients with acute cerebral infarction combined with PLMS.