JNNP:与SARS-CoV-2感染相关的急性缺血性中风研究

2022-03-16 MedSci原创 MedSci原创

在过去的一年里,全球研究界进行了前所未有的协调努力,研究感染2019冠状病毒的患者的性质、后果和治疗选择。很明显,2019冠状病毒疾病几乎影响着每个器官系统,症状和严重程度都很严重。冠状病毒疾病患者中

在过去的一年里,全球研究界进行了前所未有的协调努力,研究感染2019冠状病毒的患者的性质、后果和治疗选择。很明显,2019冠状病毒疾病几乎影响着每个器官系统,症状和严重程度都很严重。冠状病毒疾病患者中,三分之一的患者有神经疾病,感染率较高。更详细地评估这些表现的研究已经证明了各种表现和并发症。冠状病毒疾病患者的急性缺血性卒中(AIS)被报告为呈现特征和并发症,其发病率是可变的。2019冠状病毒疾病患者的预后可能受人口统计学、地理和社会经济因素以及并存症的影响。本研究主要目标是确定与这些患者的不良预后和死亡率相关的因素。本文发表在《神经病学,神经外科学和精神病学杂志》上()。

研究的中风中心总数为30个。其研究对象是美国和加拿大的19个医学中心,患者还包括来自美国和加拿大另外11个中心的患者。纳入标准为在任何纳入中心接受AIS检查(有或没有大血管闭塞(LVO))并在鼻口咽拭子样本的定性逆转录酶PCR检测中检测出SARS-CoV-2阳性的患者。收集以下冠状病毒疾病的年龄、性别、种族、合并症、存在和类型(发热、咳嗽、呼吸困难、恶心呕吐、胸痛和咽喉痛)、基线国立卫生研究院卒中量表(NIHSS)评分、LVO是否存在于无创基线成像中,缺血性中风入院和病因的实验室检查结果。共病包括吸烟、心房颤动、既往抗凝治疗、冠状动脉疾病、充血性心力衰竭、糖尿病高血压、高脂血症、既往中风、外周血管疾病和慢性肾病。LVO被定义为以下一种或多种阻塞:颅内颈内动脉、基底动脉、大脑中动脉M1和M2段以及大脑后动脉P1和P2段。缺血性卒中的病因是根据在急性卒中治疗(TOAST)标准中的试验定义的,该标准分为以下几类:心肌栓塞、大动脉动脉粥样硬化、小血管闭塞、其他已确定病因的卒中和未确定病因的卒中。

Grotta bar的mRS分数为:(A)基于年龄的总样本数;2019冠状病毒疾病的严重程度;和(C)高凝状态。改良Rankin量表

冠状病毒疾病的病因和隐性卒中(CS)的卒中进一步被定义为“隐源性卒中/ ESU国际工作组”所定义的未确定源性栓塞卒中(ESU)。选择使用系统标志物来分类COVID-19炎症的严重程度。采用了Li等人使用的中性粒细胞与淋巴细胞比率(NLR)标准:NLR≥4.5分为严重和NLR≥6.5为非常严重的炎症。D-二聚体用于评估高凝状态,阈值为≥1000 ng/mL用于高凝状态和≥2000纳克/毫升为严重高凝状态为。还收集了使用抗凝剂/抗血小板药物(阿司匹林、氯吡格雷、肝素和依诺肝素)和治疗(静脉注射组织型纤溶酶原激活剂(IV-tPA)和机械血栓切除术)的数据。本研究的主要终点是不良结局,即出院时的改良Rankin评分(mRS)为5或6。次要终点是:(A)出院时的死亡率,(B)良好的预后,定义为≤2出院时,(C)顺序mRS(移位分析),(D)症状性颅内出血(sICH)和(E)发生涉及肺、心脏或肾脏系统的住院并发症,以及存在深静脉血栓形成。症状性颅内出血的定义采用欧洲急性卒中合作研究III(ECASS III)标准。 

使用炎症严重程度(NLR)和高凝状态(D-二聚体)的决定因素对死亡率进行分层分析 

为了进行比较分析,选择了三个历史对照群体。选择这些人群是为了最大限度地减少分类偏差,并以尽可能少的重叠对研究队列进行比较。从最近发表的GWTG卒中急性缺血性卒中和COVID-19登记表中纳入了全因缺血性卒中队列。对于2019冠状病毒疾病2019冠状病毒疾病的比较,选择了全球COVID-19卒中登记册。对于LVO团队,选择了荷兰急性缺血性卒中血管内治疗多中心随机临床试验(MR CLEAN)的介入和非介入组。 

共纳入216例COVID-19型AIS患者。68.1%(147/216)年龄大于60岁,31.9%(69/216)年龄小于60岁。美国国立卫生研究院卒中量表(NIHSS)的中位数[IQR]为12.5(15.8),大血管闭塞(LVO)为44.2%(87/197)。约51.3%(98/191)的患者预后不佳,观察到的死亡率为39.1%(81/207)。年龄>60岁(aOR:5.11,95%可信区间2.08至12.56,p<0.001),糖尿病(aOR:2.66,95%可信区间1.16至6.09,p=0.021),入院时NIHSS较高(aOR:1.08,95%可信区间1.02至1.14,p=0.006),LVO(aOR:2.45,95%可信区间1.04至5.78,p=0.042),而较高的NLR水平(aOR:1.06,95%可信区间1.01至1.11,p=0.028)与不良的功能预后显著相关。

新冠肺炎相关AIS与严重残疾或死亡之间存在关联。中性粒细胞与淋巴细胞比率升高,而不是D-二聚体,可以预测发病率和死亡率。

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    2022-09-01 hb2008ye
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    2022-03-12 小刀医生
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