| Object To explore the related risk factors of progressive ischemic stroke or stroke-in-progression(SIP) and establish discriminant models to prognosis of progressing ischemic stroke earlier and explore the mechanism of progressive ischemic stroke .Methods 32 possible related factors including were compared betwe- en progressing group and no-progressing group of 446 acute ischemic stroke patients by univariate analysis,the factors were age,gender ,the history of hypertention , the history of stroke, the history of coronary heart disease , the history of Diabetes,triglyceride , high density lipoprotein ,low density lipoprotion cholesterin,activated partial thromboplastin time, total bilrubin , fibrinogen, total leukocyte count, cholesterin, blood glucose,neutrophilia,Albumin, creatinine ,Serum potassium, Serum sodium,Systolic blood pressur e, Diastolic blood pressure, baseline MAP , pulse pressure, NIHSS score when reaching hospital ,the time from stroke attacked to reaching hospital , temperature when reaching hospital, the temperature increasing and the blood pressure rapidly decreasing in 48 hours after entering hospital,OCSP subtypes , the sign of early cerebral infarction on CT, arterial stenosis, SIP or no-SIP.The significent different factors selected(p<0.05) were analyzed by logistic regression and discriminant analysis .Results 16 associated factors were found significant difference between progressing group and no-progressing group (p<0.05),They were The levels of mean arterial pressure , pulse pressure ,initial NIHSS,blood glucose, creatinine neutrophilia, low density lipoprotion, total cholesterin ,the increasing of temperature were significant higher in the progressive group.the time of entering hospital and albumin were significant lower in the progressive group .The proportions of diabetes history ,the sign of early cerebral infarction on CT, the blood pressure rapidly decreasing in 48 hours after enter hospital, and totol anterior circulation infarct in OCSP subtype were higher in the progressive group.The higher the temperature increasing in 48 hours after enter hospital,the progressive risk was higher ,the OR was 2.400 times compared 0-1℃with less than 0℃, the OR was 4.840 times compared more than 1℃with 0-1℃.the severe of arterial stenosis, the progressive risk was higher,the OR was 1.848 times compared suffered moderate arterial stenosis with little arterial stenosis ,the OR was3.026 times compared severity arterial stenosis with moderate.The more significant of the sign of early cerebral infarction on CT , the progressive risk was higher,the OR was 1.787 times compared≤33% with none, the OR was 2.981 times compared >33% with≤33% ; in OCSP subtype,the incidence rate of progressive stroke is the highest in those with TACI .the second was POCI ,then LACI,the last was PACI. compared TACI with PACI,POCI,LACI. The odds ratio was 6.451,5.272,2.536.Logistic regression(Forward LR )showed the temperature increasing and the blood pressure rapidly decreasing in 48 hours after entering hospital,OCSP subtypes ,low density lipoprotion cholesterin, the sign of early cerebral infarction on CT,creatinine , arterial stenosis, blood glucose were introduced into the modal one by one .their OR were 6.713,23.882,2.455,2.219,3.321,1.020,2.558,1.163。Use stepwise method ,Discriminant models were establish by 8 factors, including of arterial stenosis,OCSP subtype, blood glucose,low density lipoprotion cholesterin, creatinine ,the sign of early cerebral infarction on CT,the temperature increasing and the blood pressure rapidly decreasing in 48 hours after entering hospital, The evaluation to the models by interview datas and prospective datas showed that the each miscarriage of justice rate was 10.3%,11.7%. the modles: YSIP=-34.190+3.452×the temperature increasing +3.989×low density lipoprotion cholesterin +0.142×creatinine +0.951×blood glucose +5.045×arterial stenosis +9.128×e blood pressure rapidly decreasing×+3.931×the sign of early cerebral infarction on CT +3.200×OCSP subtypesYno-SIP=-19.812+1.107×the temperature increasing +3.267×low density lipoprotion cholesterin +0.119×creatinine+0.797×blood glucose +3.826×arterial stenosis group +5.491×the blood pressure rapidly decreasing group+2.712×the sign of early cerebral infarction on CT +2.290×OCSP subtypes。Conclusions1 The related factors of progressive ischemic stroke included baseline MAP , pulse pressure, initial NIHSS score when reaching hospital ,the time from stroke attacking to reaching hospital , Albumin ,the history of Diabetes , neutrophilia,cholesterin, the temperature increasing and the blood pressure rapidly decreasing in 48 hours after entering hospital,OCSP subtypes ,low density lipoprotion cholesterin, the sign of early cerebral infarction on CT,creatinine , arterial stenosis, blood glucose.2 The higher the temperature increasing in 48 hours after enter hospital,the progressive risk was higher , the severe of arterial stenosis, the progressive risk was higher, the more significant of the sign of early cerebral infarction on CT , the progressive risk was higher. in OCSP subtype,the incidence rate of progressive stroke is the highest in those with TACI .the second was POCI ,then LACI,the last was PACI.3 The temperature increasing in 48 hours after entering hospital ,the blood pressure rapidly decreasing in 48 hours after entering hospital,OCSP subtypes ,low density lipoprotion, the sign of early cerebral infarction on CT,creatinine , arterial stenosis, blood glucose are the high risk factors of the progressing ischemic stroke.4 The evaluation to the discriminant models established in the study show a satisfied result.
|
PDF Full Text Request