摘要
目的探讨急性孤立性桥脑梗死早期神经功能恶化(END)的临床及影像学特征,并分析END的预测因素。方法随访研究。收集郑州大学人民医院2020年1月至2021年12月间磁共振成像(MRI)证实为急性桥脑梗死患者,分为发生早期神经功能恶化组(END组)和早期神经功能未恶化组(NEND组),比较患者一般资料及影像学特征,并在卒中后1个月、3个月利用改良的Rankin量表(mRS量表)随访评估患者神经功能。采用多因素二元logistic回归模型分析孤立性桥脑梗死后END的危险因素,并绘制受试者工作特征(ROC)曲线,曲线下面积比较采用Z检验,判断END的最佳预测因素。结果共纳入急性孤立性桥脑梗死患者113例,男72例,女41例,年龄(62±11)岁,其中END组40例,NEND组73例,急性孤立性桥脑梗死END的发生率为35.4%(40/113)。END组入院时美国国立卫生研究院卒中量表(NIHSS)评分[(5.15±1.88)分]、梗死灶面积[(2.15±0.39)mm^(2)]大于NEND组[(4.10±1.63)分、(1.61±0.46)mm^(2)](P=0.002、P<0.001)。多因素二元logistic回归模型分析显示入院时NIHSS评分(OR=1.393,95%CI:1.017~1.909,P=0.039)、梗死灶面积(OR=11.539,95%CI:3.574~37.255,P<0.001)是END的相关因素,比较两者ROC曲线下面积,梗死灶面积(曲线下面积为0.787,灵敏度0.750,特异度0.545)预测END的价值和入院时NIHSS评分(曲线下面积为0.688,灵敏度0.700,特异度0.589)预测END的价值差异无统计学意义(P=0.056)。结论急性孤立性桥脑梗死END患者入院时NIHSS评分较高、梗死灶面积较大,且两者对孤立性桥脑梗死后END具有预测意义。
Objective To investigate the clinical and imaging characteristics of early neurological deterioration(END)in acute isolated pontine infarction(AIPI)and analyze the predictive factors of END.Methods Patients with AIPI who were confirmed by magnetic resonance imaging(MRI)in Zhengzhou University People′s Hospital from January 2020 to December 2021were collected and divided into END group and non-END group(NEND group).General data and imaging characteristics of the patients were compared between the two groups,the neurological function of patients was evaluated by using the modified Rankin scale(mRS)at 1 and 3 months after stroke.Multivariate binary logistic regression model was used to analyze the risk factors of END after isolated pontine infarction,and the receiver operating characteristic curve(ROC)curve was drawn.Z-test was used to compare the area under the curve to determine the best predictor of END.Results A total of 113 patients with AIPI were enrolled,including 72 males and 41 females,aged(62±11)years,with 40 cases in the END group and 73 cases in the NEND group.The incidence of END in AIPI was 35.4%(40/113).The National Institutes of Health Stroke Scale(NIHSS)score in the END group(5.15±1.88)was higher than that in the NEND group(4.10±1.63),and the infarcts size in the END group[(2.15±0.39)mm^(2)]was larger than that in the NEND group[(1.61±0.46)mm^(2)](P=0.002 and P<0.001,respectively).Multivariate binary logistic regression analysis showed that NIHSS score on admission(OR=1.393,95%CI:1.017-1.909,P=0.039),infarct size(OR=11.539,95%CI:3.574-37.255,P<0.001)were associated with END.Comparing the area of ROC curve,infarct size[area under curve(AUC)=0.787,with a sensitivity of 0.750 and specificity of 0.545]and NIHSS score on admission(AUC=0.688,with a sensitivity of 0.700 and specificity of 0.589)showed no significant difference in the value of predicting END(P=0.056).Conclusion Patients with AIPI had higher NIHSS score and larger infarct size on admission,and both of them exhibit good predictive performance for END.
作者
鲍婕妤
刘娜
张静
蔡萌萌
晁琳琳
刘东波
赵建华
Bao Jieyu;Liu Na;Zhang Jing;Cai Mengmeng;Chao Linlin;Liu Dongbo;Zhao Jianhua(Department of Neurology,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第1期32-37,共6页
National Medical Journal of China
基金
河南省医学科技公关计划(SBGJ2018075)
关键词
脑桥
脑梗死
早期神经功能恶化
随访研究
Pontine
Cerebral infarction
Early neurological deterioration
Follow-up study
作者简介
通信作者:赵建华,Email:jianhuaz@zzu.edu.cn
