| 急性脑梗死患者早期神经功能恶化的影响因素分析 |
| 投稿时间：2025-05-10 修订日期：2025-07-08 点此下载全文 |
| 引用本文：黄奔,刘书娜,缪淑贤,郑明选,王珏.急性脑梗死患者早期神经功能恶化的影响因素分析[J].医学研究杂志,2025,54(11):82-87 |
| DOI：
10.11969/j.issn.1673-548X.2025.11.016 |
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| 基金项目:江苏省医学重点学科项目(ZDXK202239)；江苏省科技计划项目青年基金项目(BK20241034) |
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| 中文摘要:目的 研究急性脑梗死(acute cerebral infarction, ACI)患者入院时的临床资料和实验室数据,分析与早期神经功能恶化(early neurological deterioration, END)相关的影响因素。方法 收集2023年12月~2024年11月在神经内科住院的180例ACI患者的临床资料,根据美国国立卫生研究院神经功能缺损评分(National Institute of Health Stroke Scale, NIHSS)将患者分为END组(n=66)和非END组(n=114),比较并分析两组患者临床指标的差异。采用LASSO回归和多因素Logistic回归分析END发生的影响因素。结果 END组和非END组患者在合并高血压(P=0.011)、糖尿病(P=0.033)和颈动脉狭窄率＞50%(P=0.041)方面比较,差异有统计学意义。LASSO回归和多因素Logistic回归分析结果显示,入院时的NIHSS评分(OR=1.22,95%CI:1.13~1.33,P<0.001)、神经元特异性烯醇化酶(neuron-specific enolase, NSE)(OR=1.16,95%CI:1.00~1.27,P = 0.001)是ACI患者发生END的危险因素,而血清叶酸(OR=0.91,95%CI:0.86~0.94,P<0.001)是ACI患者发生END的保护性因素。与轻度病情组相比,重度病情组患者的血清叶酸水平明显降低,NSE水平明显升高,差异有统计学意义(P<0.05)。联合患者入院时的NIHSS评分与血清叶酸、NSE三者对预测发生END的受试者工作特征的曲线下面积为0.904(95%CI:0.850~0.940)。结论 ACI患者入院时低水平的血清叶酸,高水平的NSE和NIHSS评分与END发生相关,联合三者检测对END发生具有良好的预测价值。 |
| 中文关键词:血清叶酸 NSE NIHSS评分 急性脑梗死 早期神经功能恶化 |
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| Analysis of the Influencing Factors of Early Neurological Deterioration in Patients with Acute Cerebral Infarction. |
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| Abstract:Objective To study the clinical and laboratory data of patients with acute cerebral infarction (ACI) at admission, and analyze the influencing factors related to early neurological deterioration (END). Methods Clinical data from 180 ACI patients admitted to the Department of Neurology between December 2023 and November 2024 were collected. Using the National Institutes of Health Stroke Scale (NIHSS), patients were divided into the END group (n=66) and the non-END group (n=114). The differences in clinical indicators between the two groups were compared. LASSO regression and multivariate Logistic regression analyses were conducted to identify factors influencing END occurrence. Results There were statistically significant differences between the END group and the non-END group in terms of combined hypertension (P=0.011), diabetes (P=0.033), and carotid artery stenosis rates > 50% (P=0.041). The results of LASSO and multivariate Logistic regression analysis showed that the NIHSS score at admission (OR=1.22,95%CI:1.13-1.33, P<0.001) and neuron-specific enolase (NSE) (OR=1.16,95%CI:1.06-1.27, P=0.001) were risk factors for END in patients with ACI, while serum folic acid (OR=0.91,95%CI:0.86-0.94, P<0.001) was a protective factor for the occurrence of END in patients with ACI. Compared with the mild disease group, the serum folic acid level and NSE level of patients in the severe disease group were significantly decreased, and the differences were statistically significant (P<0.05). The area under the receiver operating characteristics curve for END using the NIHSS score, serum folic acid, and NSE was 0.904 (95%CI:0.850-0.940). Conclusion Low serum folic acid levels, elevated NSE levels, and higher NIHSS scores in ACI patients at admission are associated with the occurrence of END, and the combination of these three biomarkers exhibits good predictive value for the occurrence of END. |
| keywords:Serum folic acid NSE NIHSS score Acute cerebral infarction Early neurological deterioration |
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