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卒中前体育锻炼对软脑膜侧支循环及患者预后的影响

袁长红 吴晓宇 刘群 张璐 朱迎春

袁长红, 吴晓宇, 刘群, 张璐, 朱迎春. 卒中前体育锻炼对软脑膜侧支循环及患者预后的影响[J]. 中华全科医学, 2022, 20(8): 1315-1318. doi: 10.16766/j.cnki.issn.1674-4152.002585
引用本文: 袁长红, 吴晓宇, 刘群, 张璐, 朱迎春. 卒中前体育锻炼对软脑膜侧支循环及患者预后的影响[J]. 中华全科医学, 2022, 20(8): 1315-1318. doi: 10.16766/j.cnki.issn.1674-4152.002585
YUAN Chang-hong, WU Xiao-yu, LIU Qun, ZHANG Lu, ZHU Ying-chun. Effect of pre-stroke physical activity on pial collateral circulation and patient prognosis[J]. Chinese Journal of General Practice, 2022, 20(8): 1315-1318. doi: 10.16766/j.cnki.issn.1674-4152.002585
Citation: YUAN Chang-hong, WU Xiao-yu, LIU Qun, ZHANG Lu, ZHU Ying-chun. Effect of pre-stroke physical activity on pial collateral circulation and patient prognosis[J]. Chinese Journal of General Practice, 2022, 20(8): 1315-1318. doi: 10.16766/j.cnki.issn.1674-4152.002585

卒中前体育锻炼对软脑膜侧支循环及患者预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.002585
基金项目: 

安徽省卫生计生委科研计划项目 2018SEYL029

详细信息
    通讯作者:

    袁长红, E-mail: 37547794@qq.com

  • 中图分类号: R743.3

Effect of pre-stroke physical activity on pial collateral circulation and patient prognosis

  • 摘要:   目的  探讨卒中前体育锻炼水平对急性前循环脑梗死患者软脑膜侧支循环及预后的影响。  方法  选取安徽省第二人民医院神经内科2017年1月—2020年6月收治住院的急性前循环脑梗死患者,采用CT血管造影(CTA)评价的区域软脑膜评分(rLMC)对患者软脑膜侧支循环进行半定量评估,采用现代Saltin-Grimby体育锻炼水平量表(SGPALS)对卒中前患者体育锻炼水平进行量化评估,采用改良Rankin评分(mRS)评估患者发病3个月生活自理能力,比较不同体育锻炼水平间患者rLMC的差异,及对90天改良mRS的影响。  结果  共纳入157例患者,其中低运动量组患者72例,高运动量组85例,高运动量组基线收缩压、基线NIHSS评分、发病3个月mRS评分低于低运动量组(P值分别为0.001、0.039、 < 0.001),rLMC评分高于低运动量组(P=0.023),差异有统计学意义;发病3个月99例患者预后良好(mRS≤2),58例患者预后不良(mRS>2),预后良好组SGPALS评分高于预后不良组(P<0.001),rLMC评分大于预后不良组(P<0.001),既往他汀类药物服用率高于预后不良组(P=0.041),差异有统计学意义;多因素logistic回归分析发现SGPALS评分及rLMC评分高是良好预后的保护性因素(OR=1.455、1.181;P=0.043、0.003),既往糖尿病史、基线NIHSS评分高是良好预后的危险因素(OR=0.366、0.899;P=0.027、0.023)。  结论  卒中前体育锻炼能改善急性前循环脑梗死患者软脑膜侧支循环及发病3个月临床预后。

     

  • 表  1  不同体育锻炼水平患者间资料的比较

    Table  1.   Comparison of data between patients with different levels of physical exercise

    项目 低运动量组(SGPALS评分1~2分,n=72) 高运动量组(SGPALS评分3~4分,n=85) 统计量 P
    性别[例(%)] 0.069a 0.792
      男性 40(55.56) 49(57.65)
      女性 32(44.44) 36(42.35)
    年龄(x ±s,岁) 64.10±8.11 64.36±9.96 0.182b 0.856
    血管危险因素[例(%)]
      吸烟史 28(38.89) 35(41.18) 0.085a 0.771
      高血压病 46(63.89) 52(61.18) 0.122a 0.727
      2型糖尿病 24(33.33) 26(30.59) 0.135a 0.713
      冠心病 8(11.11) 8(9.41) 0.132a 0.726
      心房颤动 11(15.28) 10(11.76) 0.415a 0.519
      高脂血症 32(44.44) 37(43.53) 0.170a 0.680
    发病前使用药物[例(%)]
      降压药物 31(43.01) 28(32.94) 3.307a 0.069
      抗血小板药物 10(13.89) 12(14.17) 0.001a 0.976
      降糖药物 18(25.00) 18(21.18) 0.322a 0.570
      他汀类药物 13(18.06) 13(15.29) 0.215a 0.643
    入院时血压(x ±s,mm Hg)
      收缩压 160.13±14.79 151.88±16.39 3.283b 0.001
      舒张压 85.46±9.42 84.09±13.78 0.711b 0.458
    基线NIHSS评分[ M(P25, P75),分] 12(8, 15) 10(8, 12) 2.069c 0.039
    发病至CTA检查时间[ M(P25, P75),h] 18.00(16.00, 21.75) 19.00(16.00, 22.50) 0.616c 0.538
    rLMC评分[ M(P25, P75),分] 11.00(8.00, 13.75) 12.00(10.00, 16.00) 2.277c 0.023
    90天mRS评分[ M(P25, P75),分] 3(2,4) 2(1,3) 3.778c <0.001
    注:a为χ2值,bt值,cZ值;1 mm Hg=0.133 kPa。
    下载: 导出CSV

    表  2  发病3个月良好预后与不良预后组间资料的比较

    Table  2.   Comparison of data between good and poor prognosis groups at 3 months after onset

    项目 mRS≤2(n=99) mRS>2(n=58) 统计量 P
    SGPALS评分[ M(P25, P75),分] 3(2,4) 2(1,3) 3.637a <0.001
    rLMC评分[ M(P25, P75),分] 12(10,15) 10(7,13) 4.027a <0.001
    性别[例(%)]
      男性 52(52.53) 37(63.79) 1.891b 0.169
      女性 47(47.47) 21(36.21)
    年龄(x ±s,岁) 64.04±9.39 64.59±8.73 0.361c 0.719
    血管危险因素[例(%)]
      吸烟史 36(36.36) 27(46.55) 1.580b 0.209
      高血压病 57(57.58) 41(70.69) 2.681b 0.102
      2型糖尿病 26(26.26) 24(41.38) 3.850b 0.050
      冠心病 9(9.09) 7(12.07) 0.354b 0.552
      心房颤动 15(15.15) 6(10.34) 0.729b 0.393
      高脂血症 42(42.42) 27(46.55) 0.253b 0.615
    发病前使用药物[例(%)]
      降压药物 39(39.39) 20(34.48) 0.376b 0.540
      抗血小板药物 12(12.12) 10(17.24) 0.796b 0.372
      降糖药物 20(20.20) 16(27.58) 0.988b 0.320
      他汀类药物 21(21.21) 5(8.62) 4.196b 0.041
    基线NIHSS评分[ M(P25, P75),分] 10.00(8.00,13.00) 12.00(8.75,15.00) 3.024a 0.002
    入院时血压(x ±s,mm Hg)
      收缩压 154.03±15.69 158.16±16.68 1.573c 0.083
      舒张压 84.14±11.88 85.55±11.13 0.711c 0.478
    注:aZ值,b为χ2值,ct值。
    下载: 导出CSV

    表  3  影响发病3个月良好预后(mRS≤2)的多因素回归分析

    Table  3.   Multivariate regression analysis of good prognosis (mRS≤2) at 3 months after onset

    影响因素 B SE Wald χ2 P OR(95% CI)
    SGPALS评分 0.375 0.185 4.087 0.043 1.455(1.012~2.093)
    rLMC评分 0.166 0.056 8.790 0.003 1.181(1.058~1.318)
    2型糖尿病史 -1.005 0.455 4.880 0.027 0.366(0.150~0.893)
    既往服用他汀药物 0.699 0.649 1.160 0.281 2.013(0.564~7.185)
    收缩压 -0.011 0.013 0.700 0.403 0.989(0.964~1.015)
    基线NIHSS评分 -0.118 0.048 6.103 0.013 0.889(0.810~0.976)
    注:SGPALS评分、rLMC评分、收缩压、基线NIHSS评分均以实际值赋值;2型糖尿病史,有=1,无=0;既往服用他汀药物,有=1,无=0。
    下载: 导出CSV
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    ZHENG L F, YANG K R, LAN Z Y, et al. The effect of multiple factors on depression in patients with acute cerebral infarction[J]. Chinese Journal of General Practice, 2017, 15(9): 1539-1541. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.027
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  • 收稿日期:  2021-11-21
  • 网络出版日期:  2022-09-26

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