进展性缺血性脑卒中危险因素分析及微栓子对卒中进展的预测价值

目的探讨进展性缺血性脑卒中(PIS)患者的危险因素及微栓子对进展性卒中的预测价值。方法纳入2016年3月至2018年3月就诊于内蒙古自治区人民医院神经内科的50例PIS患者及同时期非进展的缺血性卒中病人62例,所有纳入的患者均行头颅磁共振、颈动脉血管超声、心脏彩超、心电图、48 h内微栓子检查,并对纳入的患者进行问卷调查。结果微栓子阳性PIS患者病灶多位于皮质(P0.05)。PIS与微栓子、低密度脂蛋白异常、院前未服用阿司匹林、院前服用降压药物、颈动脉斑块等因素显著相关(P 0.05)。logistic回归分析提示微栓子(OR=7.246,P=0.001)、低密度脂蛋白异常(OR=3.879,P=0.007)、颈动脉斑块(OR=4.177,P=0.007)、院前未口服阿司匹林(OR=4.304,P=0.046)、院前服用降压药物(OR=3.734,P=0.01)为PIS的独立危险因素。结论微栓子、低密度脂蛋白异常、院前未口服阿司匹林、院前服用降压药物、颈动脉斑块是PIS危险因素,且微栓子更具预测价值。     

进展性缺血性脑卒中相关危险因素分析

脑卒中是21世纪全球老年人群病死率和致残率最高的三大疾病之一,更是我国已步人老龄化社会所面临的重大和医学难题。进展性缺血性脑卒中是指卒中发生后神经功能缺失或逐步阶梯式与发病46h～2周内继续恶化的缺血性脑卒中。进展性缺血性脑卒中（SIP）属难治性脑卒中,其发病率国内外报道不尽相同（12％～42％）。临床常规治疗欠佳,致残率、病死率较一般卒中高,病死率增加4倍以上并为其死亡的独立预测因子,严重影响了患者的预后。对进展性缺血性脑卒中相关危险因素进行分析,总结如下。     

进展性缺血性脑卒中危险因素及其预测价值研究

目的 探讨进展性缺血性脑卒中的危险因素及其预测价值。方法 将本院在2013年10月～2014年10月期间收治的226例脑卒中患者按病情是否进展分为实验组(58例)与对照组(168例); 应用实验室和影像学检测D-二聚体、空腹血糖、颈动脉斑块等相关指标。结果 2组颈动脉斑块(χ²=20.345,P<0.001)具有明显差异; 且2组的入院时收缩压(t=6.389,P<0.001)和SSS评分(t=11.800,P<0.001)也均具有明显的差异,入院后血压降低(χ²=43.560,P<0.001)也有明显差异。2组的D-二聚体(t=14.698,P<0.001)、空腹血糖(t=7.043,P<0.001)、同型半胱氨酸(t=25.902,P<0.001)等因素的差异均具有统计学意义。作多因素Logistic回归分析表明,D-二聚体(χ²=22.918,P<0.001)、空腹血糖(χ²=32.062,P<0.001)、颈动脉斑块(χ²=16.792,P<0.001)、入院后血压下降(χ²=38.270,P<0.001)、糖尿病史(χ²=4.798,P=0.0285)均有统计学意义(P<0.05)。结论 有糖尿病史的缺血性脑卒中患者若入院后其血压显著降低,且应用实验室检测静脉血中D-二聚体以及空腹血糖含量增加,或应用影像学检查颈动脉斑块时极大可能会恶化或使病情进行性加重; 即这五个因素就是进展性缺血性脑卒中的危险因素。     

进展性缺血性卒中相关危险因素分析

目的对进展性缺血性卒中(SIP)相关危险因素进行探讨。方法对我院41例SIP患者的入院时血压、血糖、体温、同型半胱氨酸、周围血白细胞、血脂、血沉、高敏C反应蛋白、梗死部位、动脉狭窄及既往病史等因素进行回顾性分析。结果SIP患者与对照组比较,入院时体温、白细胞计数、同型半胱氨酸及脑梗死部位等差异有统计学意义(P<0.05)。结论SIP多与入院时体温升高、高同型半胱氨酸及分水岭区脑梗死相关。     

进展性缺血性脑卒中患者的危险因素分析及护理对策

目的对进展性缺血性脑卒中患者的危险因素进行分析,并提出相应护理对策。方法选取2011-04—2012-09到我院诊治的298例患者,采用1∶1配对病例进行对照研究,其中149例进展性缺血性脑卒中患者为实验组,另149例非进展性脑血卒中患者为对照组,对所有患者进行调查和实验室检测,内容包括性别、年龄、脑血管家族史、血脂、血糖、血压、血浆同型半胱氨酸浓度等14项相关危险因素,进行统计分析,并制定相应的护理对策。结果高血压、糖尿病、心脏病、血脂异常、吸烟史及脑血管病家族史是导致缺血性脑卒中的危险因素,而血糖、甘油三酯、纤维蛋白原水平、收缩压、LDL的升高及发热是临床护理进展性缺血性脑卒中患者中常见的危险因素。结论应针对进展性缺血性脑卒中患者的临床常见危险因素制定护理方案,可以有效的提高其临床疗效。     

缺血性进展性脑卒中危险因素临床分析

目的探讨进展性缺血性脑卒中临床诊断与治疗中的危险因素。方法选取2010—2013年我院住院治疗的进展性与非进展性缺血性脑卒中患者各40例,对2组患者的临床资料进行对比分析。结果 2组患者高热、高血压发生率无明显差异(P0.05),观察组高血糖、同型半胱氨酸偏高比例以及降压后进展率均明显高于对照组(P0.05),颈动脉不稳定斑块检出率、中度与重度狭窄率明显高于对照组(P0.05),各项生化指标均与对照组差异显著(P0.05)。结论降压不合理、生化指标(血糖、全血黏度、纤维蛋白原偏高,高密度脂蛋白偏低)异常、颈动脉不稳定斑块以及中重度狭窄均为进展性缺血性脑卒中的危险因素。     

缺血性进展性脑卒中危险因素临床分析

目的探讨进展性卒中(progressive stroke,PS)的危险因素。方法对我院收治的63例缺血性进展性卒中患者的临床资料,与同期住院的63例非进展性脑梗死患者进行回顾性分析研究。结果PS组患者并发高血压、脉压差小者、高血糖、感染比例及神经功能缺损评分明显高于对照组;影像学检查病灶显示较早,TCD多显示大血管狭窄者与对照组比较差异有统计学意义。结论高血压、脉压差小者、糖尿病、血管狭窄是进展性脑梗死患者的危险因素。感染、神经功能缺损程度,影像学检查显示病灶出现早也是相关因素。对上述因素干预,可改善患者愈后。     

进展性脑卒中的相关危险因素分析

进展性脑卒中(SIP)是指脑缺血所致的神经症状在起病6h至2周仍逐渐加重[1],是脑血栓形成的一个亚型,属难治性脑血管病,其病死率、致残率均较高。回顾分析我科收治诊断明确的SIP患者临床资料,对其血压、血糖、血脂和24h内的体温进行分析。1临床资料1.1病例选择近几年我科住院治疗     

进展性缺血性脑卒中的影响因素

进展性缺血性脑卒中简称进展性脑卒中（stroke in progression,SIP）。Petzold等提出,SIP将导致急性缺血性脑卒中的病死率和致残率增加。因此,开展对SIP等的研究十分重要。对SIP的研究,包括诊断标准、发病机制、病因、危险因素、发生率、预测指标等。清楚SIP的危险因素,对SIP的预防至关重要。从临床可干预的角度,SIP的影响因素可分为不可干预部分和可干预部分,前者包括脑卒中类型、梗死部位和面积、脑卒中严重程度等,后者包括血压、血糖、发热、感染、并发症等。对可干预部分进行干预,可以起到预防SIP发生的作用。     

进展性缺血性脑卒中相关因素探讨

目的探讨进展性缺血性脑卒中相关因素。方法 2008-01-2011-01收治的符合诊断标准的进展性缺血性脑卒中65例为观察组,选取同期非进展性缺血性脑卒中患者80例为对照组,观察2组相关因素。结果观察2组病例入院48h内体温、血压、血胆固醇、低密度脂蛋白、血糖、纤维蛋白原并进行比较,差异有统计学意义（P〈0.05）。结论进展性缺血性脑卒中相关因素进行分析,体温、血压、血胆固醇、低密度脂蛋白、血糖、纤维蛋白原是常见的相关因素,应在疾病发生早期避免和消除相关因素,减少进展性缺血性脑卒中发生。     

Risk factors for progressive ischemic stroke——A retrospective analysis

BACKGROUND: Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE: To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN: A retrospective analysis. SETTING: Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS: Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of (62±7) years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke (135 males and 65 females) were selected as the control group. METHODS: After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES: Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS: All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance: There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group (P < 0.01); The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group (P < 0.05–0.01). ② Results of the multivariate Logistic regression analysis: The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure (OR =2.61, 2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92–3.59, P < 0.05–0.01). CONCLUSION: History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke     

缺血性进展性脑卒中相关危险因素分析

目的 探讨缺血性进展性脑卒中(PIS)的相关危险因素,为PIS的预防和治疗提供参考.方法 对524例缺血性脑卒中患者的临床资料进行回顾性分析,将患者分为进展组和非进展组,对PIS中的相关危险因素进行Logistic回归分析,筛选发生PIS的相关危险因素.结果 单因素分析结果显示,有糖尿病史、有高血压史、有颈动脉粥样硬化的患者比例在进展组显著高于非进展组(P＜0.05);入院时血糖值、NIHSSS评分、纤维蛋白原水平在进展组也显著高于非进展组(P＜0.05).多因素Logistic回归分析表明,有糖尿病史、有颈动脉粥样硬化、入院时血糖值高是PIS发生的危险因素(OR分别为3.796、1.251、3.883、P＜0.05).结论 有糖尿病史、有颈动脉粥样硬化和入院时血糖值高是PIS发生的危险因素,对这些危险因素加以重点评估和合理控制对于防治PIS的发生有重要的临床意义.     

青年缺血性脑卒中患者病因及相关危险因素分析

目的探讨青年缺血性卒中患者病因及危险因素。方法收集71例青年缺血卒中患者及80例中老年缺血性卒中患者的临床资料,同时选取140例青年健康体检自然人群作为对照,进行病因及相关危险因素分析。结果青年缺血组TOAST病因分型按比例依次为大动脉粥样硬化型（LAA）40.8%、小动脉闭塞型（SAO）28.2%、不明原因型（UND）15.5%、其它原因型（OTH）9.9%、心源性栓塞型（CE）5.6%。与中老年缺血组比较,其UND型比例明显增高（P〈0.05）。青年缺血性脑卒中易患因素依次为吸烟、高脂血症、高血压病、糖尿病、心脏病。与中老年缺血性组相比,青年缺血组中男性患者比例显著增高（P〈0.05）。结论青年缺血性卒中以LAA型最常见;其发病为多因素共同作用结果。     

缺血性进展性脑卒中的危险因素：来自19篇队例研究和10篇病例对照研究的系统评价

目的 为认识和了解进展性缺血性脑卒中可干预的危险因素,以利于预防其发生和判断预后,我们对进展性脑卒中危险因素的相关文献进行系统评价,为进展性脑卒中的诊断和治疗提供理论依据。 方法 检索Medline(1966-2007)数据库,中国生物医学数据库(CBM-disc 1979 - 2007),中国期刊全文数据库(www.cnki.net 1979 - 2007),再从选中文献的参考文献目录里筛选相关文献,纳入符合设定标准的队列研究和病例对照研究进行系统评价。 结果 从检索到的781篇中英文文献中纳入符合标准的文献29篇,其中队列研究19篇,病例对照研究10篇,对文献中有关进展性缺血卒危险因素的原始数据进行Meta分析,与进展性卒中显著相关的因素有：①发热：（RR 2.26, 95% CI 1.20, 4.26;OR 2.85,95% CI 1.64,4.98);②糖尿病史：（RR 1.38, 95% CI 1.18, 1.61; OR 2.48, 95% CI 1.93, 3.19）;③冠心病史：（RR 1.22, 95% CI 1.08, 1.38）;④早期影像改变：（RR 1.55, 95% CI 1.34, 1.80;OR 2.29, 95% CI 1.47, 3.58）;⑤高血糖：（RR 2.62, 95% CI 1.86, 3.68;OR 3.49, 95% CI 1.92, 6.35）;相对危险因素：①头痛病史：（RR 7.95, 95% CI 4.53,13.95; OR 2.81, 95% CI 1.10, 7.18）;②高纤维蛋白原（RR 1.20, 95% CI 1.02, 1.41）;无相关性因素：血清铁蛋白（RR 0.93, 95% CI0.33, 2.64）。其他因素因缺乏符合要求的资料没能进行meta分析。 结论 通过系统评价,我们认为发热、糖尿病史、冠心病史、早期影像改变、高血糖是进展性缺血性脑卒中重要的危险因素,而头痛病史、高纤维蛋白原与其发生的相关性不强,血清铁蛋白无明显相关性。及时干预上述危险因素能有效的预防进展性卒中的发生。今后的此类研究应尽可能采用统一的、实用性强的诊断标准,并对进展性卒中的预后进行随访观察,从中探索出影响其发生发展的可靠病因。     

急性缺血性卒中后肺炎的危险因素及远期预后分析

目的探讨急性缺血性卒中后肺炎发生的危险因素及远期预后。方法收集544例急性缺血性卒中患者的临床资料,分析发生卒中后肺炎的相关危险因素并评估其对远期预后的影响。结果卒中后肺炎组年龄≥80岁、高血压、心房纤颤、既往卒中或TIA史、慢性呼吸系统疾病、合并恶性肿瘤、NIHSS评分≥15分、GCS评分≤8分、卧床时间≥7 d、吞咽障碍、早期鼻饲、早期应用质子泵受体阻滞剂、早期应用糖皮质激素、基线空腹血糖≥7.0 mmol/L、低蛋白血症、贫血的比率均显著高于无肺炎组;早期康复治疗的比率明显低于无肺炎组(均P0.05)。Logistic回归分析显示,年龄≥80岁、NIHSS评分≥15分、GCS评分≤8分、卧床时间≥7 d、吞咽障碍、基线空腹血糖≥7.0 mmol/L、低蛋白血症是卒中后肺炎的独立危险因素,早期康复治疗是卒中后肺炎的保护因素。卒中后肺炎组患者预后良好的比率显著低于无肺炎组(P0.05)。结论年龄≥80岁、NIHSS评分≥15分、GCS评分≤8分、卧床时间≥7 d、吞咽障碍、基线空腹血糖≥7.0 mmol/L、低蛋白血症是卒中后肺炎发生的独立危险因素。卒中后肺炎是导致预后不良的重要影响因素。     

进展性缺血性脑卒中预后影响因素分析

目的探讨进展性缺血性脑卒中预后影响因素。方法86例诊断为进展性缺血性脑卒中的患者,依其抗血小板聚集,扩容等一般性治疗后MRS(改良的Rankin量表)评分分为预后好和预后差(含死亡者)两组。记录患者的9个参数:性别、年龄、血糖情况、体温、NIHSS评分、头颅MRI影象学改变、医源性原因、脑动脉狭窄与否和是否连用低分子肝素钙。用单变量logistic回归分析得出与进展性缺血性脑卒中预后显著相关的变量,后用多变量stepwiselogistic回归分析得出预后的最佳回归方程。结果logistic回归分析表明与进展性缺血性脑卒中预后显著相关的独立变量包括:血糖、体温、NIHSS评分、脑动脉狭窄与否、是否用低分子肝素钙和头颅MRI影象学改变。结论本研究显示进展性缺血性脑卒中的预后和血糖、体温、NIHSS评分、脑动脉狭窄与否、是否用低分子肝素钙和头颅MRI影象学改变关系密切。     

Risk factors for and incidence of subtypes of ischemic stroke

The TOAST classification divides patients with ischemic stroke into five subgroups according to the presumed etiological mechanism. The aims of the present study were to evaluate the distribution of the different etiological stroke subtypes in a hospital-based sample of stroke patients, and to investigate the association between important risk factors and stroke subtypes. A total of 210 patients with a first-ever ischemic stroke admitted to the stroke unit of Asker and B?rum Hospital in Norway between February 2007 and July 2008 were enrolled in the study. Information on vascular risk factors was collected at admittance, examination of neurological deficits was carried out during their stay, and classification was made according to the TOAST criteria. According to the TOAST classification, 24 (11.4%) of the patients suffered from large vessel disease, 66 (31.4%) from cardioembolic disease, 66 (31.4%) from small vessel disease and 54 (25.7%) from a stroke of undetermined etiology. The presence of hyperlipidemia and atrial fibrillation varied significantly between the different subtypes. In multivariate analyses, hyperlipidemia [odds ratio (OR) 2.46, 95% confidence interval (CI) 1.32-4.60] and current smoking (OR 2.06, 95% CI 1.04-4.08) were the only variables that were related to small vessel disease. Small vessel disease was observed more frequently and large vessel disease less frequently than previously reported. Small vessel disease was significantly associated with hyperlipidemia and current smoking. Our study supports the view that the etiology of lacunar strokes is multifactorial.