Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack
Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack
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DOI：
10.1212/wnl.0000000000010603
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发表时间：
2020-10-20
期刊：
影响因子：
9.9
通讯作者：
Bae, Hee-Joon
中科院分区：
文献类型：
--
作者：
Park, Tai Hwan;Lee, Jeong-Kon;Bae, Hee-Joon
目的提高对急性缺血性卒中（AIS）患者神经功能恶化（ND）的流行病学认识。方法在这项前瞻性观察性研究中，我们前瞻性地在韩国15家医院收治的29，446例AIS患者中采集ND，患者在卒中发作后7天内入院。ND定义为NIH卒中量表（NIHSS）评分增加>= 2（总分），或>= 1（运动或意识），或任何新的神经系统症状。中风发作后，原因，与ND，修改后的兰金量表（mRS）评分在3个月和1年的发病率的变化，并在1年的中风，心肌梗死和全因死亡的复合材料进行了assessed.ResultsND发生在4,299（14.6%）例。发病率最高的是发病后6小时内，为6.95/1000人-小时，24-48小时内降至2.09，72-96小时内降至0.66。老年、女性、糖尿病、早期到达、大动脉粥样硬化作为卒中亚型、NIHSS评分高、血糖水平、收缩压、入院时白细胞增多、再通治疗、无相关病变的TIA和相关动脉狭窄闭塞与ND相关。原因为卒中进展（71.8%），其次为复发（8.5%）。3个月和1年时不良结局（mRS 3-6）的校正相对风险（95% CI）分别为1.75（1.70-1.80）和1.70（1.65-1.75）。复合事件的校正危险比（95%CI）为1.59（1.45-1.74）。结论ND是影响急性缺血性脑卒中预后的一个重要因素。
ObjectiveTo improve epidemiologic knowledge of neurologic deterioration (ND) in patients with acute ischemic stroke (AIS).MethodsIn this prospective observational study, we captured ND prospectively in 29,446 patients with AIS admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in NIH Stroke Scale (NIHSS) score >= 2 (total), or >= 1 (motor or consciousness), or any new neurologic symptoms. Change in incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) score at 3 months and 1 year, and a composite of stroke, myocardial infarction, and all-cause death at 1 year were assessed.ResultsND occurred in 4,299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence, was within the first 6 hours, which decreased to 2.09 within 24-48 hours, and 0.66 within 72-96 hours after stroke onset. Old age, female sex, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, TIA without a relevant lesion, and steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%) followed by recurrence (8.5%). Adjusted relative risks (95% CI) for poor outcome (mRS 3-6) at 3 months and 1 year were 1.75 (1.70-1.80) and 1.70 (1.65-1.75), respectively. The adjusted hazard ratio (95% CI) for the composite event was 1.59 (1.45-1.74).ConclusionsND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.