Study Of Risk Factors And Clinical Characteristics Of Wake-up Ischemic Stroke

Objective: To explore the risk factors for wake-up stroke and the relationship between different subtypes and related risk factors.Methods: The patients with acute ischemic stroke(ASI)who visited the Neurology of the First Affiliated Hospital of Hainan Medical University from November 2021 to October 2022 were collected.According to the onset time,the collected cases were divided into wake-up stroke group(WUS)and non wake-up stroke group(NWUS).The clinical data of patients in each group were collected,including Demographics characteristics,past medical history,risk factors,laboratory examination indicators,NIHSS score,TOAST classification Compare the differences between the two groups based on clinical data such as imaging data.Then,according to the TOAST classification,NIHSS score,and different infarct sites,the wake-up stroke was divided into different subgroups: according to the TOAST classification,it was divided into large Atherosclerosis type,Arteriole occlusion type,cardiogenic embolism type,other types with clear causes and unknown causes.The large Atherosclerosis type was classified into large Atherosclerosis type group(LAA),and the other etiology types were classified into non large Atherosclerosis type group;According to the NIHSS score at admission,they are divided into a mild neurological deficit group(NIHSS ≤ 4)and a moderate to severe neurological deficit group(NIHSS ≥ 5);According to the results of the film review,the new infarct site was divided into anterior circulation group,posterior circulation group,and both anterior and posterior circulation affected group.The differences in risk factors among different subgroups were analyzed.Result: According to the inclusion and exclusion criteria,272 patients were ultimately included,including 64 patients in the wake-up stroke group and 208 patients in the non wake-up stroke group.Univariate analysis showed that there were no significant differences between the WUS group and the NWUS group in gender,hypertension,diabetes,hyperlipidemia,atrial fibrillation,coronary heart disease,previous stroke history,admission random blood glucose,creatinine,uric acid,C-reactive protein,triglyceride,High-density lipoprotein,lipoprotein a,homocysteine,Glycated hemoglobin,NIHSS score,infarct site,and related etiological subtypes(P>0.05);The age of the WUS group was lower than that of the NWUS group,and the proportion of smokers and drinkers was higher than that of the NWUS group.The levels of lowdensity lipoprotein,cholesterol,and albumin were higher than those of the NWUS group,and the difference was statistically significant(P<0.05);There was no statistically significant difference in the four platelet parameters between the two groups(P>0.05).In subgroup analysis,according to different TOAST subtypes,the number of atrial fibrillation,proportion of alcohol consumption,and blood uric acid levels in the LAA group were lower than those in the non LAA group(P<0.05);There was no significant difference in age,cholesterol,High-density lipoprotein,low-density lipoprotein,gender,hypertension,diabetes,hyperlipidemia,coronary heart disease history,previous stroke,smoking history,NIHSS,random blood glucose,creatinine,C-reactive protein,albumin,triglyceride,lipoprotein a,homocysteine,and Glycated hemoglobin between the other two groups(P>0.05).According to different infarct sites,the levels of cholesterol,low-density lipoprotein and High-density lipoprotein in patients with posterior circulation infarction were higher than those in patients with anterior circulation infarction(P<0.05),and the difference was statistically significant.Other age,sex,hypertension,diabetes,hyperlipidemia,atrial fibrillation,coronary heart disease history,previous stroke,smoking history,drinking history,NIHSS,random blood glucose,creatinine,uric acid,C-reactive protein,albumin,triglyceride,lipoprotein a,homocysteine,Glycated hemoglobin were not statistically significant(P>0.05).Compared with NIHSS ≤ 4 group and NIHSS ≥ 5 group,the proportion of women in NIHSS ≥ 5 group,the level of High-density lipoprotein is higher than that in NIHSS ≤ 4 group,the proportion of people with drinking history,the level of albumin and triglyceride is lower than that in NIHSS ≤ 4 group,and the age,cholesterol,low-density lipoprotein,high blood pressure,diabetes,hyperlipidemia,atrial fibrillation,history of coronary heart disease,previous stroke,smoking history,random blood glucose,creatinine,uric acid,C-reactive protein,lipoprotein a There was no significant difference between homocysteine and Glycated hemoglobin groups(P>0.05).Multivariate logistic regression analysis showed that smoking and lowdensity lipoprotein were both statistically significant(P<0.05)in the model,and they were both risk factors for stroke after awakening.The higher the smoking history and low-density lipoprotein,the greater the risk of stroke after awakening.In the subgroup analysis of wake up stroke,alcohol consumption was independently associated with the occurrence of wake up stroke of non major Atherosclerosis type.Conclusion:(1)Patients with a history of smoking and higher levels of LDL were more likely to have wake-up stroke;(2)There was no significant difference in the four parameters of platelet on admission between wake-up stroke and non-waking stroke.(3)Wake-up stroke patients with a history of alcohol consumption were more likely to have non-atherosclerotic cerebral infarction.