JNNP:与SARS- CoV- 2感染相关的急性缺血性卒中

2022-01-31 从医路漫漫 MedSci原创

COVID- 19最初认为是一种呼吸系统疾病。研究感染这一病毒的患者的病情、结局和治疗方案。

背景:COVID- 19最初认为是一种呼吸系统疾病。研究感染这一病毒的患者的病情、结局和治疗方案。很明显,COVID- 19会影响到几乎每个器官系统,症状和严重程度各不相同。三分之一的COVID- 19患者可出现神经系统症状,在感染较严重的患者中出现的频率更高更详细地评估这些表现的研究显示了各种表现和并发症据报道,急性缺血性卒中(AIS)既是COVID- 19的一种表现特征,也是其并发症,其发病率有不同的估计。冠状病毒-2019(COVID- 19)神经系统症状患者的预后可能受到人口、地理和社会经济因素以及合并症的影响。

目的:分析新冠肺炎(COVID- 19)合并急性缺血性卒中(AIS)的临床特点,并确定预测功能预后的因素。

方法:对2020年3月14日至8月30日在美国和加拿大30个卒中中心就诊的COVID- 19 AIS患者进行多中心回顾性队列研究。主要终点为不良的功能结果,定义为出院时改良Rankin量表(mRS)为5或6。次要终点包括预后良好(mRS≤2)、出院时死亡率、序次mRS(移位分析)、症状性颅内出血(sICH)和住院并发症的发生。

结果:共纳入230例COVID- 19型AIS患者。67.0%(154/230)年龄大于60岁,33.0%(76/230)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12.0(17.0),42.8%(89/208)出现大血管闭塞(LVO)。大约50.2%(102/203)的患者预后不良,观察到的死亡率为38.8%(35/219)。年龄:60岁(aOR: 4.60, 95% CI 1.89 - 12.15, p=0.001),糖尿病(aOR: 2.53, 95% CI 1.14 - 5.79, p=0.025),入院时NIHSS增加(aOR: 1.10, 95% CI 1.05 - 1.16, p<0.001), LVO (aOR: 3.02, 95% CI 1.27 - 7.44, p=0.014),无静脉tPA (aOR:2.76, 95% CI 1.06 ~ 7.64, p=0.043)与功能预后不良显著相关。

图1 mRS得分的Grotta bar: (A)基于年龄的总样本;(二)COVID- 19炎症的严重程度;和(C)血凝过快。mRS,改良Rankin量表。

表1 纳入患者的转归(n=216)

表2 不良结果的决定因素(mRS 5-6) (n=216)

表3 mRS评分降低的决定因素(n=216)

表4 决定死亡率的因素(n=216)

图2使用炎症严重程度(NLR)和高凝性(D-二聚体)的决定因素对死亡率进行分层分析。NLR:中性粒细胞与淋巴细胞的比值。

结论:COVID- 19相关的AIS可能与严重残疾或死亡有关。我们确定了几个预测更糟结果的因素,与全球平均水平相比,这些结果出现的频率更高。我们发现,升高的中性粒细胞与淋巴细胞比值,而不是D-二聚体,可以预测发病率和死亡率。

原文出处:Dmytriw AA,  Dibas M,  Phan K,et al.Acute ischaemic stroke associated with SARS-CoV-2 infection in North America.J Neurol Neurosurg Psychiatry 2022 Jan 25

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    2022-02-02 小刀医生
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    2022-02-01 robbert123

    学习

    0

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    2022-01-31 yangchou

    好文章 谢谢分享。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1806498, encodeId=4b6a180649838, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 01 23:37:22 CST 2022, time=2022-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893473, encodeId=59c618934e3e8, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Mon Sep 19 23:37:22 CST 2022, time=2022-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1321346, encodeId=78ef132134664, content=<a href='/topic/show?id=ac0d159007f' target=_blank style='color:#2F92EE;'>#SARS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15900, encryptionId=ac0d159007f, topicName=SARS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8306486, createdName=小刀医生, createdTime=Wed Feb 02 06:37:22 CST 2022, time=2022-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189597, encodeId=565f118959ec1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82d31990773, createdName=robbert123, createdTime=Tue Feb 01 21:30:23 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189487, encodeId=2ffd118948e53, content=好文章 谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Jan 31 21:19:25 CST 2022, time=2022-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189484, encodeId=42c5118948463, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Mon Jan 31 20:12:43 CST 2022, time=2022-01-31, status=1, ipAttribution=)]
    2022-01-31 医鸣惊人

    认真学习了

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