急性缺血性脑卒中在院内发生的风险因素及预测价值分析

迪丽达热·艾尔肯; 西合热扎提·阿布力米提; 田睿思

doi:10.16766/j.cnki.issn.1674-4152.004195

急性缺血性脑卒中在院内发生的风险因素及预测价值分析

doi: 10.16766/j.cnki.issn.1674-4152.004195

新疆医科大学第二附属医院康复医学科，新疆乌鲁木齐 830000

基金项目:

新疆维吾尔自治区自然科学基金资助项目 2022D01C276

详细信息

通讯作者:
田睿思，E-mail：1044110761@qq.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2025-01-28

Analysis of influencing factors and predictive value of in-hospital acute ischemic stroke

Department of Rehabilitation Medicine, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China

摘要

摘要: 目的鉴于院内发生的急性缺血性脑卒中(IHS)因患者基础疾病复杂、治疗背景特殊，常导致诊断延迟和预后不良，本研究旨在识别IHS发生的独立危险因素，并评估其预测价值，为临床早期识别和干预提供依据。方法回顾性选取2015年1月—2020年1月于新疆医科大学第二附属医院神经内科住院发生急性缺血性脑卒中的85例患者作为院内组，选取同期因急性缺血性脑卒中住院的170例患者作为对照组(院外组)。分析2组患者的一般资料，采用logistic回归分析研究影响院内急性缺血性脑卒中发生的因素；采用受试者工作特征曲线(ROC)分析各因素对院内急性缺血性脑卒中的预测价值。结果心功能不全(OR=5.202, 95% CI：1.436~18.849)、发病时mRS评分≥3分(OR=3.602, 95% CI：1.809~7.175)、围手术期(OR=4.085, 95% CI：1. 391~11. 997)、前循环+后循环梗死(OR=1.959, 95% CI：1.270~3.022)、心源性栓塞型(OR=2.312, 95% CI：1.257~4.253)均为院内急性缺血性卒中发生的独立危险因素(P<0.05)。心功能不全、发病时高mRS评分、围手术期、前循环+后循环梗死、心源性栓塞型预测IHS的AUC分别为0.705、0.720、0.736、0.751、0.782，5项指标联合预测的AUC为0.913。结论心功能不全、发病时高mRS评分、围手术期、前循环+后循环梗死及心源性栓塞型梗死是影响IHS发生的独立危险因素，并对IHS的发生具有一定的预测价值。
- 急性缺血性卒中 /
- 院内 /
- 影响因素 /
- 预测价值
Abstract: Objective Given that in-hospital acute ischemic stroke (IHS) is often associated with diagnostic delays and poor prognosis due to patients' complex underlying conditions and specific treatment backgrounds, this study aims to identify independent risk factors for IHS and evaluate their predictive value, so as to provide a basis for early clinical identification and intervention. Methods A retrospective analysis was conducted on 85 cases of acute ischemic stroke admitted to the Department of Neurology of the Second Affiliated Hospital of Xinjiang Medical University, from January 2015 to January 2020. The 85 cases were included as the in-hospital group, and 170 cases hospitalized due to acute ischemic stroke during the same period were selected as the control group (out-of-hospital group). The general information between the two groups of patients was analyzed. Logistic regression was used to analyze the factors of in-hospital acute ischemic stroke. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of each factor for acute ischemic stroke in the hospital. Results Cardiac insufficiency (OR=5.202, 95% CI: 1.436-18.849), mRS score at onset (≥3 points, OR=3.602, 95% CI: 1.809-7.175), perioperative period (OR=4.085, 95% CI: 1.391-11.997), combined anterior and posterior circulation infarction (OR=1.959, 95% CI: 1.270-3.022), and cardiogenic embolism (OR=2.312, 95% CI: 1.257-4.253) were identified as independent risk factors for the occurrence of acute ischemic stroke in hospital (P<0.05). The AUCs of IHS for cardiac insufficiency, high mRS score at onset, perioperative period, combined anterior and posterior circulation infarction, and cardiogenic embolism were 0.705, 0.720, 0.736, 0.751 and 0.782, respectively. The combined prediction of all five indicators yielded an AUC of 0.913. Conclusion Cardiac insufficiency, mRS score at onset, perioperative period, combined anterior and posterior circulation infarction, and cardiogenic embolic infarction are independent risk factors affecting the occurrence of IHS. These factors have certain significant predictive value for the occurrence of IHS.
- Acute ischemic stroke /
- In-hospital /
- Influencing factors /
- Predictive value
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图 1 各指标预测IHS发生的ROC曲线

Figure 1. ROC curves of individual indicators for predicting HIS

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表 1 院内卒中组与院外卒中组患者基线资料比较

Table 1. Comparison of baseline data between the in-hospital stroke group and the out-of-hospital stroke group

项目	院内组(n=85)	院外组(n=170)	统计量	P值
性别[例(%)]
男性	40(47.1)	112(65.9)	8.339^a	0.004
女性	45(52.9)	58(34.1)
年龄(x±s，岁)	61.73±14.63	62.58±13.99	0.452^b	0.652
吸烟[例(%)]	42(49.4)	73(42.9)	0.958^a	0.328
饮酒[例(%)]	39(45.9)	63(37.1)	1.838^a	0.175
高血压[例(%)]	54(63.5)	110(64.7)	0.034^a	0.853
糖尿病[例(%)]	19(22.4)	56(32.9)	3.060^a	0.080
高脂血症[例(%)]	35(41.2)	63(37.1)	0.406^a	0.524
颈动脉斑块[例(%)]	67(78.8)	146(85.9)	2.052^a	0.152
心肌梗死[例(%)]	10(11.8)	15(8.8)	0.554^a	0.457
心房颤动[例(%)]	17(20.0)	17(10.0)	4.094^a	0.027
心功能不全[例(%)]	24(28.2)	12(7.1)	20.959^a	<0.001
既往卒中史[例(%)]	11(12.9)	27(15.9)	0.387^a	0.534
肾功能不全[例(%)]	21(24.7)	7(4.1)	24.573^a	<0.001
肺栓塞[例(%)]	2(2.4)	13(7.6)	2.859^a	0.090
发热[例(%)]	40(47.1)	26(15.3)	29.805^a	<0.001
围手术期[例(%)]	46(54.1)	0	112.249^a	<0.001
发病前治疗[例(%)]
抗血小板药	22(25.9)	50(29.4)	0.348^a	0.555
抗凝药	14(16.5)	19(11.2)	1.410^a	0.235
降脂药	18(21.2)	45(26.5)	0.854^a	0.355
发病时mRS评分(x±s，分)	3.89±0.90	2.52±1.29	9.850^b	<0.001
发病时NIHSS评分[M(P₂₅, P₇₅), 分]	7.00(3.00，14.00)	4.00(2.00，6.00)	5.100^c	<0.001
白细胞计数(x±s，×10⁹/L)	11.55±5.14	8.05±2.78	5.856^b	<0.001
血红蛋白(x±s，g/L)	113.47±27.77	133.30±19.34	5.905^b	<0.001
CRP[M(P₂₅, P₇₅), mg/L]	14.00(5.09，64.50)	12.00(3.67，34.31)	1.824^c	0.068
D-二聚体[M(P₂₅, P₇₅), ng/mL]	890.00(560.00，1 292.00)	242.00(97.00，835.25)	6.758^c	<0.001
Fib(x±s，g/L)	4.40±1.33	2.99±1.14	8.357^b	<0.001
梗死分布[例(%)]			7.106^a	0.029
前循环	51(60.0)	103(60.6)
后循环	14(16.5)	46(27.1)
前循环+后循环	20(23.5)	21(12.4)
TOAST分型[例(%)]			40.186^a	<0.001
大动脉粥样硬化型	21(24.7)	69(40.6)
小动脉闭塞型	20(23.5)	73(42.9)
心源性栓塞型	25(29.4)	23(13.5)
其他原因型	19(22.4)	5(2.9)
不明原因型	0	0
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
卒中情况	院外组=0，院内组=1
性别	男性=1，女性=2
心房颤动	否=0，是=1
心功能不全	否=0，是=1
肾功能不全	否=0，是=1
发热	否=0，是=1
围手术期	否=0，是=1
梗死分布	哑变量：前循环(有=1，无=0), 后循环(有=1，无=0), 前循环+后循环(有=1，无=0)
TOAST分型	哑变量：大动脉粥样硬化型(有=1，无=0), 小动脉闭塞型(有=1，无=0), 心源性栓塞型(有=1，无=0), 其他原因型(有=1，无=0)
发病时mRS评分	<3分=0，≥ 3分=1
注：其余连续性变量均以实际值赋值。

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表 3 IHS影响因素的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of factors influencing IHS

变量	B	SE	Waldχ²	P值	OR值(95% CI)
心功能不全	0.038	0.059	0.422	0.048	1.039(1.043~1.289)
发病时mRS评分	0.596	0.188	10.081	0.001	1.814(1.202~2.574)
围手术期	0.703	0.218	10.441	0.001	2.021(1.239~3.015)
前循环+后循环梗死	0.229	0.103	4.938	0.026	1.257(1.056~2.250)
心源性栓塞型	0.404	0.152	7.069	0.008	1.498(1.257~3.055)
注：本表仅列出差异有统计学意义的变量。

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表 4 各因素对IHS发生的预测效能分析

Table 4. Assessment of the predictive performance of various risk factors for IHS

项目	AUC	95% CI	灵敏度(%)	特异度(%)	约登指数
心功能不全	0.705	0.247~0.852	68.55	71.25	0.490
发病时mRS评分≥3分	0.720	0.339~0.796	73.47	73.03	0.551
围手术期	0.736	0.235~0.856	69.05	73.27	0.471
前循环+后循环梗死	0.751	0.348~0.808	73.28	77.05	0.549
心源性栓塞型	0.782	0.351~0.814	74.99	78.19	0.536
联合	0.913	0.686~0.959	87.92	86.33	0.737

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参考文献(17)

[1]	CHAPMAN L, KENNEDY O, BRADLEY D, et al. Clinical validation of in-hospital stroke diagnosis[J]. J Stroke Cerebrovasc Dis, 2023, 32(9): 107278. DOI: 10.1016/j.jstrokecerebrovasdis.2023.107278.
[2]	GARG A, ROEDER H, LEIRA E C. In-hospital outcomes and recurrence of stroke during pregnancy and puerperium[J]. Int J Stroke, 2023, 18(4): 445-452. doi: 10.1177/17474930221116209
[3]	余文娟, 郑红建, 余双娟, 等. 脑卒中后吞咽障碍患者PG-SGA评分与不良预后风险的相关性[J]. 中华全科医学, 2024, 22(4): 586-588, 681. doi: 10.16766/j.cnki.issn.1674-4152.003456 YU W J, ZHENG H J, YU S J, et al. Correlation between PG-SGA score and risk of poor prognosis in post-stroke dysphagia patients[J]. Chinese Journal of General Practice, 2024, 22(4): 586-588, 681. doi: 10.16766/j.cnki.issn.1674-4152.003456
[4]	刘凯, 王伊龙, 李子孝, 等. 尿激酶静脉溶栓治疗急性缺血性卒中/短暂性脑缺血发作的院内死亡率及相关影响因素的多中心分析[J]. 中国卒中杂志, 2020, 15(10): 1078-1082. LIU K, WANG Y L, LI Z X, et al. Multi center analysis of in-hospital mortality and related influencing factors in the treatment of acute ischemic stroke/transient ischemic attack with intravenous thrombolysis with urokinase[J]. Chinese Journal of Stroke, 2020, 15(10): 1078-1082.
[5]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. Chinese Medical Association Neurology Branch, Cerebrovascular Disease Group of Chinese Medical Association Neurology Branch Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2023[J]. Chinese Journal of Neurology, 2018, 51(9): 666-682.
[6]	何家礼, 莫云. 卒中单元院前急救流程对提高急性缺血性脑卒中患者静脉溶栓效果的分析[J]. 中外医药研究, 2023, 2(33): 121-123. HE J L, MO Y. Analysis of the effect of pre hospital emergency procedures in stroke units on improving the effectiveness of intravenous thrombolysis in patients with acute ischemic stroke[J]. Chinese and Foreign Medical Research, 2023, 2(33): 121-123.
[7]	李宏建. 2型糖尿病患者的首次卒中风险及其与血糖控制的关系[J]. 国际脑血管病杂志, 2020, 28(3): 167. LI H J. Risk of first stroke and its relationship with blood glucose control in patients with type 2 diabetes[J]. International Journal of Cerebrovascular Disease, 2020, 28(3): 167.
[8]	张俊青, 魏亚琳, 张丽娜, 等. 睡眠时间及体力活动与缺血性脑卒中的相关性研究进展[J]. 青岛大学学报(医学版), 2020, 56(5): 627-630. ZHANG J Q, WEI Y L, ZHANG L N, et al. Research progress on the correlation between sleep time, physical activity and ischemic stroke[J]. Journal of Qingdao University (Medical Edition), 2020, 56(5): 627-630.
[9]	孙瑶, 杨志明. 窦性心律心力衰竭患者脑卒中风险评估的研究进展[J]. 心血管病学进展, 2023, 44(6): 528-531, 550. SUN Y, YANG Z M. Research progress on stroke risk assessment in patients with sinus rhythm heart failure[J]. Advances in Cardiovascular Diseases, 2023, 44(6): 528-531, 550.
[10]	金铁, 丁继, 崔凯, 等. 环状RNA CDC14A表达与急性缺血性脑卒中发生风险、严重程度及复发的相关性研究[J]. 心脑血管病防治, 2024, 24(2): 50-53. JIN T, DING J, CUI K, et al. The correlation between the expression of circular RNA CDC14A and the risk, severity, and recurrence of acute ischemic stroke[J]. Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, 2024, 24(2): 50-53.
[11]	龚倩倩, 宋春江, 龙秀英, 等. 恶性肿瘤相关性脑梗死的临床特点及相关危险因素分析[J]. 肿瘤预防与治疗, 2019, 32(2): 193-198. GONG Q Q, SONG C J, LONG X Y, et al. Analysis of the clinical characteristics and related risk factors of cerebral infarction associated with malignant tumors[J]. Cancer Prevention and Treatment, 2019, 32(2): 193-198.
[12]	曹志明, 万小旭, 刘艳芳. 急性缺血性脑卒中患者卒中后抑郁简易风险评分系统的构建[J]. 内蒙古医学杂志, 2023, 55(9): 1029-1034. CAO Z M, WAN X X, LIU Y F Construction of a simplified risk scoring system for post-stroke depression in patients with acute ischemic stroke[J]. Inner Mongolia Medical Journal, 2023, 55(9): 1029-1034.
[13]	李辉. 重视围手术期脑卒中的识别与管理[J]. 中华外科杂志, 2024, 62(7): 619-623. LI H. Pay attention to the identification and management of perioperative stroke[J]. Chinese Journal of Surgery, 2024, 62(7): 619-623.
[14]	韦紫君, 东格尔·雅其乐, 曹孟欣, 等. 首次发病前循环、后循环急性小动脉闭塞性脑卒中病人的临床特点和预后比较[J]. 中西医结合心脑血管病杂志, 2022, 20(19): 3615-3619. CAO M X, YAO Y Y, WANG Y, et al. Comparison of clinical characteristics and prognosis of patients with acute small artery occlusion stroke before and after the first onset of circulation[J]. Journal of Integrated Traditional Chinese and Western Medicine for Cardiovascular and Cerebrovascular Diseases, 2022, 20(19): 3615-3619.
[15]	任婧, 邵枝定, 许忠强. 前、后循环颅内动脉粥样硬化的缺血性卒中患者的预后观察[J]. 局解手术学杂志, 2022, 31(7): 591-595. REN J, SHAO Z D, XU Z Q. Prognostic observation of ischemic stroke patients with anterior and posterior circulation intracranial atherosclerosis[J]. Journal of Surgical Surgery, 2022, 31(7): 591-595.
[16]	张咪咪, 李妮妮. 心源性脑卒中危险因素分析及预防对策探讨[J]. 贵州医药, 2020, 44(11): 1754-1755. ZHANG M M, LI N N. Analysis of risk factors and exploration of prevention strategies for cardiogenic stroke[J]. Guizhou Pharmaceutical, 2020, 44(11): 1754-1755.
[17]	曹誉竞, 陈灏. 心源性卒中诊疗的研究进展[J]. 临床医学进展, 2023, 13(5): 7069-7077. CAO Y J, CHEN H. Research progress on diagnosis and treatment of cardiogenic stroke[J]. Clinical Medical Progress, 2023, 13(5): 7069-7077.