文章摘要
汪文兵,徐钧,邵凌云,等.营养状态对静脉溶栓治疗急性缺血性卒中病人功能预后的影响[J].安徽医药,2023,27(6):1121-1125.
营养状态对静脉溶栓治疗急性缺血性卒中病人功能预后的影响
Effect of nutritional status on the functional prognosis of patients with acute ischemic stroke undergoing intravenous thrombolysis therapy
  
DOI:10.3969/j.issn.1009-6469.2023.06.014
中文关键词: 卒中  血栓溶解疗法  营养评价  营养不良  脑梗死  血清白蛋白  预后
英文关键词: Stroke  Thrombolytic therapy  Nutrition assessment  Malnutrition  Cerebral infarction  Serum albumin  Prognosis
基金项目:国家自然科学基金项目( 81701061)
作者单位E-mail
汪文兵 芜湖市第一人民医院神经内科安徽芜湖 241001  
徐钧 芜湖市第一人民医院神经内科安徽芜湖 241001  
邵凌云 芜湖市第一人民医院神经内科安徽芜湖 241001  
何敏 芜湖市第一人民医院神经内科安徽芜湖 241001  
左健 芜湖市第一人民医院神经内科安徽芜湖 241001  
吴芳草 芜湖市第一人民医院神经内科安徽芜湖 241001  
陈后勤 芜湖市第一人民医院神经内科安徽芜湖 241001 459151573@qq.com 
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中文摘要:
      目的探讨营养状态对接受静脉溶栓治疗的急性缺血性卒中( AIS)病人功能预后的影响以及各营养评估工具的预测作用。方法回顾性收集芜湖市第一人民医院 2017年 8月至 2021年 4月期间行阿替普酶静脉溶栓治疗的 AIS病人 111例,中改良 Rankin量表评分( mRS)≤2分的病人纳入预后良好组( 79例)mRS评分 ≥3分纳入预后不良组( 32例)。收集入组病人的其基线数据、发病 -静脉溶栓( ONT)时间、入院到静脉溶栓( DNT)时间、,体质量、身高、血清白蛋白、血清总胆固醇、淋巴细胞总数以及预后相关指标。采用单因素和多因素分析方法分析三种营养指数对病人 90 d功能预后影响的差异,并绘制受试者操作特征( ROC)曲线,评估营养指数评分( PNI)和控制性营养状态评分( CONUT)的预测价值。结果全部病人的入院基线美国国立卫生研究院卒中量表(NIHSS)评分 7(4,13)分, ONT时间( 165.62±59.67)min,DNT时间( 45.86±16.48)min,90 d改良 Rankin量表(mRS)评分 1(1,3)分。其中,预后良好组入院 NIHSS评分 6(4,9)分, ONT时间( 166.42±62.09)min,DNT时间( 47.34±17.31) min,mRS评分 1(0,2)分。预后不良组入院 NIHSS评分 14(10,18)分, ONT时间( 163.66±54.13)min,DNT时间( 42.22±13.80) min,mRS评分 4(3,5)分。单因素分析显示两组间 PNI、CONUT和综合营养风险指数( GNRI)差异有统计学意义,多因素分析显示:低 PNI值( P=0.006)和高 CONUT值( P=0.018)是不良预后的高危因素,而 GNRI未发现与不良预后相关( P=0.058)。 CONUT指数和 PNI指数预测价值差异无统计学意义( P=0.931)。结论较低的 PNI指数和较高的 CONUT指数与急性缺血性卒中静脉溶栓病人的 90 d功能预后不良相关,且二者的预测效能相同。
英文摘要:
      Objective To explore the effect of nutritional status on the functional prognosis of patients with acute ischemic stroke(AIS) treated by intravenous thrombolysis and the predictive role of each nutritional assessment tool.Methods A retrospective collection of 111 patients with AIS who underwent alteplase intravenous thrombolysis from August 2017 to April 2021 at the First People′sHospital of Wuhu City was performed, in which patients with a modified Rankin Scale score (mRS) ≤ 2 were included in the good prognosis group (79 cases), and those with an mRS score ≥ 3 were included in the poor prognosis group (32 cases). The baseline data, onset-intravenous thrombolysis (ONT) time, admission-to-intravenous thrombolysis (DNT) time, weight, height, serum albumin, serum total cholesterol, total lymphocyte count and prognosis-related indicators were collected from the enrolled patients. Univariate and multivariate analyses were used to analyze the differences in the effects of the three nutritional indexes on the 90-d functional prognosis of patients and to plot the operational characteristics of subjects (ROC) curves to assess the predictive value of the nutritional index score(PNI) and the controlled nutritional status score (CONUT).Results The baseline of the National Institutes of Health Stroke Scale (NIHSS) score of all patients was 7 (4,13) on admission, ONT time was (165.62±59.67) min, DNT time was (45.86±16.48) min, and 90-d mRS score was 1 (1, 3). Among them, the good prognosis group had an admission NIHSS score of 6 (4, 9), ONT time of (166.42±62.09)min, DNT time of (47.34±17.31) min, and mRS score of 1 (0, 2). The poor prognosis group had an admission NIHSS score of 14 (10,18), ONT time of (163.66±54.13) min, DNT time of (42.22±13.80) min, and mRS score of 4 (3, 5). Univariate analysis showed that PNI,CONUT and combined nutritional risk index (GNRI) were statistically significant differences between the two groups, while multivariateanalysis showed that low PNI value (P=0.006) and high CONUT values (P=0.018) were high risk factors for poor prognosis, while GNRI was not found to be related to poor prognosis (P=0.058).There was no statistically significant difference in the predictive value between the CONUT index and the PNI index (P=0.931).Conclusion A lower PNI index and a higher CONUT index were associated with poor 90-d functional prognosis in patients with AIS with intravenous thrombolysis, and both had the same predictive efficacy.
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