老年脑卒中患者预后不良危险因素筛选及其相互作用探索

摘要/Abstract

摘要：

目的：旨在探索急性缺血性脑卒中（acute ischemic stroke, AIS）后复发的危险因素及其相互作用。方法：选取2020年3月至2023年3月在本院治疗的AIS患者143例，收集患者一般临床资料，进行随访，随访终点为脑卒中复发。失访12例。采用COX分析筛选脑卒中复发的危险因素，分析各危险因素间的相互作用。结果：单因素COX分析显示，年龄、改良Rankin评分量表（modified Rankin scale, mRS）评分、美国国立卫生研究院卒中量表（the National Institutes of Health stroke scale, NIHSS）评分、活化部分凝血酶时间、糖尿病病史是AIS老年患者预后不良的危险因素[风险比（hazard ratio, HR）>1,P<0.05]。蒙特利尔认知评估量表（Montreal cognitive assessment scale, MoCA）评分和纤维蛋白原是AIS老年患者预后良好的保护因素（HR<1,P<0.05）。多因素分析进一步表明，高mRS评分和高NIHSS评分是预后不良的独立危险因素，而高MoCA评分和高纤维蛋白原水平是独立保护因素（均P<0.05）。然而，这些因素之间未发现显著的相互作用。结论：mRS评分和NIHSS评分是AIS老年患者预后不良的独立危险因素。MoCA评分和纤维蛋白原AIS老年患者预后良好的独立保护因素。这些危险因素和保护因素之间无显著相互作用。

关键词:老年,急性缺血性脑卒中,复发,危险因素

Abstract:

ObjectiveTo explore the risk or protective factors and their interactions for recurrence after acute ischemic stroke (AIS).MethodsA total of 143 AIS patients admitted in our hospital from March 2020 to March 2023 were selected and followed up, and general clinical data were collected. Twelve patients were lost to follow-up. The end point of follow-up was stroke recurrence. The risk factors of stroke recurrence were screened by COX analysis, and the interaction between risk factors was analyzed.ResultsUnivariate COX analysis showed that age, modified Rankin scale (mRS) score, the National Institutes of Health stroke scale (NIHSS) score, activated partial thrombin time and diabetes history were risk factors for poor prognosis in elderly patients with AIS [hazard ratio (HR) > 1,P< 0.05]. Montreal cognitive assessment scale (MoCA) score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1,P> 0.05). Multivariate COX analysis showed that mRS score and NIHSS score were independent risk factors for poor prognosis in elderly patients with AIS (HR > 1,P> 0.05). MoCA score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1,P> 0.05). Patients with high mRS score and high NIHSS score had worse prognosis (P< 0.001). Patients with high MoCA score and high fibrinogen level had better prognosis (P< 0.001). mRS score, NIHSS score, MoCA score and fibrinogen level had no significant interaction.ConclusionsmRS score and NIHSS score are independent risk factors for poor prognosis in elderly patients with AIS. MoCA score and independent protective factor of good prognosis in elderly patients with AIS of fibrinogen. There was no significant interaction between these risk factors and protective factors.

Key words:Elderly,Acute ischemic stroke,Recurrence,Risk factor

中图分类号:

R541.75

徐婷, 戎捷骊, 顾仁丽, 徐阳, 刘小江. 老年脑卒中患者预后不良危险因素筛选及其相互作用探索[J]. 内科理论与实践, 2025, 20(04): 296-300.

XU Ting, RONG Jieli, GU Renli, XU Yang, LIU Xiaojiang. Screening of risk or protective factors for prognosis and their interaction in elderly patients with stroke[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(04): 296-300.

图/表5

表1

无复发组和复发组临床变量比较[$\bar{x} \pm s$/n(%)]

变量	无复发组(n=89)	复发组(n=42)	t	P
年龄 (岁)	72.69±9.14	76.02±9.37	1.935	0.055
男性([n(%)]	49(55.06)	25(59.52)	0.232	0.630
吸烟史[n(%)]	31(34.83)	20(47.62)	1.963	0.161
饮酒史[n(%)]	37(41.57)	19(45.24)	0.157	0.692
糖尿病病史[n(%)]	35(39.33)	26(61.90)	5.846	0.016
高血压病史[n(%)]	37(41.57)	23(54.76)	1.999	0.157
高脂血症史[n(%)]	35(39.33)	14(33.33)	0.438	0.508
冠心病史[n(%)]	32(35.96)	16(38.10)	0.056	0.813
NIHSS评分 (分)	16.80±6.08	33.26±13.45	9.668	<0.001
MoCA评分 (分)	27.78±10.43	17.21±2.39	6.476	<0.001
mRS 评分 (分)	2.08±1.65	3.98±0.99	6.883	<0.001
凝血酶原时间 (s)	27.04±2.96	26.72±4.09	0.509	0.612
活化部分凝血酶时间 (s)	11.51±0.91	12.99±1.97	5.895	<0.001
纤维蛋白原 (g/L)	4.84±1.09	3.17±0.61	9.257	<0.001
发病至溶栓时间 (h)	3.10±0.54	3.00±0.97	0.757	0.450

表1

表2

单因素COX分析筛选急性缺血性脑卒中老年患者预后的危险因素

变量	B	SE	Wald	P	HR	95%CI
变量	B	SE	Wald	P	HR	下限	上限
吸烟史	0.336	0.314	1.141	0.286	1.399	0.756	2.589
年龄	0.041	0.018	5.203	0.023	1.041	1.006	1.078
mRS评分	0.187	0.040	29.374	<0.001	1.206	0.745	1.871
MoCA评分	-0.127	0.029	18.660	<0.001	0.881	0.832	0.933
NIHSS评分	0.065	0.011	35.652	<0.001	1.068	1.045	1.091
发病至溶栓时间	-0.119	0.277	0.183	0.669	0.888	0.516	1.530
高血压病史	0.077	0.316	0.060	0.807	1.080	0.581	2.008
高脂血症	-0.482	0.337	2.050	0.152	0.618	0.319	1.195
冠心病	0.283	0.321	0.777	0.378	1.327	0.707	2.491
活化部分凝血酶时间	0.464	0.107	18.760	<0.001	1.590	1.289	1.962
凝血酶原时间	0.000	0.051	0.000	0.996	1.000	0.905	1.105
糖尿病病史	0.652	0.322	4.101	0.043	1.918	1.021	3.604
纤维蛋白原	-0.935	0.174	28.922	<0.001	0.393	0.279	0.552
性别	0.071	0.318	0.049	0.824	1.073	0.576	2.001
饮酒史	0.135	0.314	0.184	0.668	1.144	0.618	2.117

表2

表3

多因素COX分析筛选急性缺血性脑卒中老年患者预后的独立危险因素

变量	B	SE	Wald	P	HR	95%CI
变量	B	SE	Wald	P	HR	下限	上限
mRS评分	0.183	0.041	6.541	0.011	1.201	0.832	1.976
MoCA评分	-0.137	0.050	7.479	0.006	0.872	0.791	0.962
NIHSS评分	0.035	0.014	6.629	0.010	1.036	1.009	1.064
活化部分凝血酶时间	0.147	0.100	2.129	0.145	1.158	0.951	1.410
糖尿病病史	0.577	0.357	2.616	0.106	1.781	0.885	3.584
纤维蛋白原	-0.439	0.190	5.333	0.021	0.644	0.444	0.936
年龄	0.211	0.147	3.391	0.149	1.113	0.547	1.883

表3

图1

变量	HR	95%CI	P
mRS评分*MoCA评分	1.364	0.885	1.774	0.320
mRS评分*NIHSS评分	1.012	0.607	1.401	0.457
mRS评分*纤维蛋白原	0.825	0.554	1.117	0.461
NIHSS评分*MoCA评分	1.750	0.975	1.456	0.342
NIHSS评分*纤维蛋白原	1.570	0.925	1.108	0.283
MoCA评分*纤维蛋白原	0.918	0.597	2.133	0.200

表4

参考文献19

[1]	Feske SK. Ischemic stroke[J].Am J Med,2021,134(12):1457-1464.
[2]	Herpich F, Rincon F. Management of acute ischemic stroke[J].Crit Care Med,2020,48(11):1654-1663.
[3]	Walter K. What is acute ischemic stroke?[J].JAMA,2022,327(9):885. doi:10.1001/jama.2022.1420pmid:35230392
[4]	Joundi RA, Menon BK. Thrombus composition, imaging, and outcome prediction in acute ischemic stroke[J].Neurology,2021,97(20Suppl 2):S68-S78.
[5]	Zubair AS, Sheth KN. Emergency care of patients with acute ischemic stroke[J].Neurol Clin,2021,39(2):391-404. doi:10.1016/j.ncl.2021.02.001pmid:33896525
[6]	韩艺, 赵丽蓉, 张丽, 等. 老年脑卒中患者生活质量特征及影响因素分析[J].老年医学与保健,2021,27(5):959-961.
	Han Y, Zhao LR, Zhang L, et al. Analysis of the characteristics and influencing factors of the quality of life of elderly stroke patients[J].Geriatr Health Care,2021,27(5)959-961.
[7]	Staessens S, De Meyer SF. Thrombus heterogeneity in ischemic stroke[J].Platelets,2021,32(3):331-339.
[8]	Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions[J].Neurology,2021,97(20Suppl 2):S6-S16.
[9]	Kolmos M, Christoffersen L, Kruuse C. Recurrent ischemic stroke—a systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2021,30(8):105935.
[10]	Oza R, Rundell K, Garcellano M. Recurrent ischemic stroke: strategies for prevention[J].Am Fam Physician,2017,96(7):436-440. pmid:29094912
[11]	Kwah LK, Diong J. National institutes of health stroke scale (NIHSS)[J].J Physiother,2014,60(1):61. doi:10.1016/j.jphys.2013.12.012pmid:24856948
[12]	Yi K, Nakajima M, Ikeda T, et al. Modified Rankin scale assessment by telephone using a simple questionnaire[J].J Stroke Cerebrovasc Dis,2022,31(10):106695.
[13]	Vasquez KA, Valverde EM, Aguilar DV, et al. Montreal cognitive assessment scale in patients with Parkinson disease with normal scores in the Mini-Mental State Examination[J].Dement Neuropsychol,2019,13(1):78-81.
[14]	Davis SM, Donnan GA. Clinical practice: secondary prevention after ischemic stroke or transient ischemic attack[J].N Engl J Med,2012,366(20):1914-1922.
[15]	Zhuo Y, Wu J, Qu Y, et al. Clinical risk factors associated with recurrence of ischemic stroke within two years: a cohort study[J].Medicine (Baltimore),2020,99(26):e20830.
[16]	张淑君, 李礼, 王舒. Essen卒中风险评分(ESRS)预测性能的系统综述[J].中风与神经疾病杂志,2022,39(7):624-630.
	Zhang SJ, Li L, Wang S. Predictive performance of Essen stroke risk score: a systematic review[J].J Apoplexy and Nervous Diseases,2022,39(7):624-630.
[17]	Hankey GJ, Wee CK. Predicting early recurrent stroke with the recurrence risk estimator[J].JAMA Neurol,2016,73(4):376-378. doi:10.1001/jamaneurol.2015.5047pmid:26928865
[18]	Stahmeyer JT, Stubenrauch S, Geyer S, et al. The frequency and timing of recurrent stroke: an analysis of routine health insurance data[J].Dtsch Arztebl Int,2019,116(42):711-717. doi:10.3238/arztebl.2019.0711pmid:31711561
[19]	Garcia-Avila J, Torres SD, Rodriguez CA, et al. Predictive modeling of soft stretchable nanocomposites using recurrent neural networks[J].Polymers (Basel),2022,14(23):5290.