河北医科大学学报 ›› 2024, Vol. 45 ›› Issue (9): 1025-1029.doi: 10.3969/j.issn.1007-3205.2024.09.007

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老年后循环缺血性卒中患者预后及危险因素分析

  

  1. 1.河北省承德市中心医院神经内科，河北 承德 067000；2.河北省承德市中心医院急诊科，
    河北 承德 067000；3.承德钢铁集团有限公司职工医院神经外科，河北 承德 067100；
    4.河北省承德市中心医院放射医学影像科，河北 承德 067000

  • 出版日期:2024-09-25 发布日期:2024-10-09
  • 作者简介:崔秀英（1983-），女，河北承德人，河北省承德市中心医院主治医师，医学硕士，从事神经病学疾病诊治研究。
  • 基金资助:
    承德市科学技术研究与发展计划（202002A010）

Analysis of prognosis and risk factors in elderly patients with posterior circulation ischemia

  1. 1.Department of Neurology, Chengde Central Hospital, Hebei Province, Chengde 067000, China; 
    2.Department of Emergency, Chengde Central Hospital, Hebei Province, Chengde 067000, China; 
    3.Department of Neurosurgery, Staff Hospital of Chengde Iron and Steel Group Co., Ltd. , 
    Hebei Province, Chengde 067100, China; 4.Department of Radiology & Imaging, 
    Chengde Central Hospital, Hebei Province, Chengde 067000, China

  • Online:2024-09-25 Published:2024-10-09

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摘要： 目的 探讨老年后循环缺血性卒中患者预后及危险因素。
方法 选取河北省承德市中心医院老年后循环缺血性卒中患者120例，根据治疗后3个月预后情况进行分组，分析预后不良和良好患者临床一般资料、外周血空腹血糖、糖化血红蛋白（hemoglobin A1c，HbA1c）等差异，总结老年后循环缺血性卒中患者预后的影响因素。
结果 预后不良患者39例，预后不良发生率为32.50%。预后不良组年龄和入院期间最高美国国立卫生研究所卒中量表（National Institute of Health Stroke Scale，NIHSS）评分分别为（68.93±4.02）岁和（19.30±2.50）分，高于预后良好组（P＜0.05）。预后不良组空腹血糖、HbA1c、脂蛋白相关磷脂酶a2（lipoprotein associated phospholipase A2，LP-PLA2）、超敏C反应蛋白（high-sensitivity C-reactive protein，hs-CRP）和血小板活化因子（platelet activating factor，PAF）分别为（7.28±0.92）mmol/L、（7.02±0.86）%、（330.50±65.53）μg/L、（20.22±6.43）ng/L和（248.23±44.18）ng/L，高于预后良好组（P＜0.05）。Logistic回归分析，显示年龄、入院期间最高NIHSS评分、空腹血糖、LP-PLA2、PAF是患者预后的影响因素（P＜0.05）。构建的方程预测预后不良的ROC曲线下面积为0.884（95%CI：0.821～0.948），P＜0.05，敏感度和特异度分别为84.60%和81.50%。
结论 老年后循环缺血性卒中患者预后不良比例高，预后情况受患者年龄、入院期间最高NIHSS评分、空腹血糖、LP-PLA2、PAF的影响，同时由此构建的模型对患者预后不良具有较高的预测价值。


关键词: 缺血性卒中, 后循环缺血, 老年

Abstract: Objective To explore the prognosis and risk factor of elderly patients with posterior circulation ischemia (PCI). 
Methods A total of 120 patients with PCI in Chengde Central Hospital were selected and grouped according to the prognosis at 3 months after treatment. The differences in clinical data, fasting peripheral blood glucose (FBG), and hemoglobin A1C(HbA1c) between patients with poor prognosis and those with good prognosis were analyzed.  
Results There were 39 patients with poor prognosis, and the incidence of poor prognosis was 32.50%. The age of patients with poor prognosis and the highest National Institutes of Health Stroke Scale (NIHSS) score during admission were (68.93±4.02) years and (19.30±2.50) points, respectively, which were significantly higher than those with good prognosis (P＜0.05). The FBG, HbA1c, lipoprotein-associated phospholipase a2 (Lp-PLA2), high-sensitivity C-reactive protein (hs CRP) and platelet activating factor (PAF) in poor prognosis group were (7.28±0.92) mmol/L, (7.02±0.86)%, (330.50±65.53) μg/L, (20.22±6.43) ng/L and (248.23±44.18) ng/L, respectively, which were significantly higher than those in good prognosis group (P＜0.05). Logistic regression analysis showed that age, the highest NIHSS score during hospitalization, FBG, Lp-PLA2, and PAF were the prognostic factors of patients (P＜0.05). The area under the receiver operating characteristic predicted by this equation for poor prognosis was 0.884 (95%CI: 0.821-0.948), (P＜0.05), and the sensitivity and specificity were 84.60% and 81.50%, respectively. 
Conclusion The proportion of poor prognosis in elderly patients with PCI is high, and the prognosis is affected by the age of patients, the highest NIHSS score during hospitalization, FBG, Lp-PLA2, and PAF. Meanwhile, the model constructed by this method has high predictive value for the poor prognosis of patients. 


Key words: ischemic stroke, posterior circulation ischemia, elderly

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