Zhongguo cuzhong zazhi (Sep 2019)
急性孤立性脑桥梗死神经功能缺损进展的危险因素分析 Analysis of Risk Factors for Neurological Deficit Progression in Acute Isolated Pontine Infarction
Abstract
目的 探讨急性孤立性脑桥梗死（acute isolated pontine infarction，AIPI）神经功能缺损进展的危险 因素、病因分型及预后。 方法 回顾性分析2015年1月-2018年6月在西安交通大学第二附属医院神经内科住院的AIPI患者临 床资料，根据其是否存在神经功能缺损进展，将患者分为进展组与非进展组。记录两组患者一般资 料、病因分型、椎-基底动脉延长扩张症（vertebrobasilar dolichoectasia，VBD）的发生率及预后，通过多 元逻辑回归分析确定AIPI神经功能缺损进展的危险因素。 结果 最终纳入122例AIPI患者，进展组28例（23.0%），非进展组94例（77.0%）。进展组在糖尿病 患病率、入院时吞咽障碍发生率及出院时mRS评分均高于非进展组，差异具有统计学意义。进展组 病因分型中基底动脉分支动脉疾病（basilar artery branch disease，BABD）有16例（57.1%），小动脉疾病 （small artery disease，SAD）有2例（7.1%），大动脉闭塞性疾病（large artery occlusive disease，LAOD）有 10例（35.7%），进展组与非进展组差异有统计学意义（χ 2=8.739，P =0.013）。进展组VBD的发生率为 25.0%（7/28），高于非进展组的13.8%（13/94），但两组比较差异无统计学意义（P =0.267）。相比非 进展组，进展组不良预后比例显著增加（46.4% vs 10.6%，P <0.001）。Logistic回归分析显示，吞咽障 碍是AIPI神经功能缺损进展的独立危险因素（OR 4.610，95%CI 1.461～14.546，P =0.009）。 结论 AIPI的患者，当存在糖尿病、吞咽障碍、VBD、病因分型BABD时可能更容易出现神经功能缺损 进展；吞咽障碍是AIPI神经功能缺损进展的独立危险因素；发生神经功能缺损进展的AIPI患者预后 不良的发生率增高。 Abstract: Objective To analyze the risk factors, etiological subtype and prognosis of neurological deficit progression in acute isolated pontine infarction (AIPI). Methods The data of AIPI patients consecutively admitted in Department of Neurology , the Second Affiliated Hospital of Xi'an Jiao Tong University from January 2015 to June 2018 were retrospectively analyzed. According to whether there was neurological deficit progression or not, all the patients were divided into progression group and non-progression group. The baseline clinical data, causative classification subtypes, incidence of vertebrobasilar dolichoectasia (VBD) and prognosis of the two groups were recorded and analyzed. Multivariate logistic regression analysis was used to analyze the risk factors of neurological deficit progression in AIPI. Results Finally, a total of 122 AIPI patients were included, with 28 cases (23.0%) in progression group and 94 cases (77.0%) in non-progression group. The rate of diabetes, dysphagia on admission and the mRS score at discharge in progression group were all higher than that in non-progression group (P <0.05). The causative classification subtypes of the two groups had statistical difference (χ 2=8.739, P =0.013), the progression group had 16 cases (57.1%) of basilar artery branch disease (BABD), 2 cases (7.1%) of small artery disease (SAD) and 10 cases (35.7%) of large artery occlusive disease (LAOD). The incidence of VBD in progression group (25%) was higher than that in non-progression group (13.8%), but there was no statistical difference between the two groups (P =0.267). Compared to the non-progression group, the rate of poor prognosis in progression group significantly increased (46.4% vs 10.6%, P <0.001). Logistic regression analysis showed that dysphagia was an independent risk factor for neurological deficit progression in AIPI patients (OR 4.610, 95%CI 1.461-14.546, P =0.009). Conclusions Diabetes, dysphagia, VBD and the BABD of causative classification subtype were associated with neurological deficit progression in AIPI patients, and dysphagia was an independent risk factor for neurological deficit progression. The incidence of poor prognosis significantly increased in AIPI patients after neurological deficit progression.
Keywords
