基于倾向性评分匹配法评估急性缺血性脑卒中神经功能改善的影响因素分析

汤爱洁; 牛淑珍; 刘怡凡; 王温情; 杨红艳; 戴秀娟; 吴茜

doi:10.16766/j.cnki.issn.1674-4152.002308

基于倾向性评分匹配法评估急性缺血性脑卒中神经功能改善的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002308

1.
同济大学医学院，上海 200092
2.
同济大学附属上海市第十人民医院胃肠外科，上海 200072
3.
安徽医科大学护理学院，安徽合肥 230601

基金项目:

国家自然科学基金青年科学基金项目 71704135

详细信息

通讯作者:
吴茜, E-mail: qian_wu2010@163.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2021-01-27
- 网络出版日期: 2022-03-04

Analysis of the influencing factors of neurological improvement in acute ischemic stroke on the basis of propensity score matching

1.
School of Medicine, Tongji University, Shanghai 200092, China

摘要

摘要: 目的探讨急性缺血性脑卒中(AIS)患者神经功能改善的影响因素。方法选取上海市第十人民医院2019年6月—2020年6月首次缺血性卒中的247例患者为研究对象，根据出院时患者美国国立卫生研究院卒中量表(NIHSS)减少的百分率分为非显著提高组(< 46%)和显著提高组(≥46%)；使用1∶ 1倾向性评分匹配方法控制一般资料及入院NIHSS分值，对匹配后的患者采用logistic回归，研究神经功能改善的影响因素。结果匹配前，MBI(Z=2.030，P=0.042)、mRs(Z=2.996，P=0.003)、入院NIHSS评分(Z=2.501，P=0.012)、睡眠时长(χ²=9.486，P=0.009)和认知障碍(χ²=31.598，P < 0.001)在2组间差异有统计学意义；匹配后，睡眠时长(χ²=8.161，P=0.017)、糖尿病(χ²=6.092，P=0.014)、认知障碍(χ²=21.066，P < 0.001)在2组间差异比较有统计学意义。将匹配后2组比较中P < 0.1的变量(糖尿病、睡眠时长、认知障碍)纳入logistic回归分析，结果显示睡眠时长(OR=1.667，95% CI：1.043~2.664，P=0.033)，MoCA(OR=4.697，95% CI：1.973~11.185，P < 0.001)可能是影响神经功能改善的危险因素。结论睡眠时长越短、卒中后早期认知功能障碍对AIS短期预后有不利影响。
- 缺血性卒中 /
- 短期预后 /
- 美国国立卫生研究院卒中量表 /
- 神经功能改善 /
- 急性期
Abstract: Objective To explore the factors influencing the improvement of neurological function in patients with acute ischemic stroke (AIS). Methods A total of 247 patients with first ischemic stroke from June 2019 to June 2020 in Shanghai Tenth People's Hospital were selected as the research objects, and the patients were divided into the non-significantly improved group (< 46%) and significantly improved group (≥ 46%) according to the percentage reduction in National Institutes of Health Stroke Scale (NIHSS) at discharge. The 1∶ 1 propensity score matching method was used to control the general data of patients the admission NIHSS score, and logistic regression was used for matched patients to analyse the influencing factors of neurological function improvement. Results Before matching, MBI (Z=2.030, P=0.042), mRs (Z=2.996, P=0.003), admission NIHSS score (Z=2.501, P=0.012), sleep duration (χ²=9.486, P=0.009) and cognitive impairment (χ²=31.598, P < 0.001) showed a statistically significant difference between both groups. After matching, sleep duration (χ²=8.161, P=0.017), diabetes (χ²=6.092, P=0.014) and cognitive impairment (χ²=21.066, P < 0.001) showed a statistically significant difference between both groups. After matching, the variables (diabetes, sleep duration, cognitive impairment) with P < 0.1 in the comparison between both groups were entered into logistic regression analysis. Results showed that sleep duration (OR=1.667, 95% CI: 1.043-2.664, P=0.033) and MoCA (OR=4.697, 95% CI: 1.973-11.185, P < 0.001) were risk factors affecting the improvement of neurological function. Conclusion Shorter sleep duration and early cognitive dysfunction after stroke have an adverse effect on the short-term prognosis of AIS.
- Ischemic stroke /
- Short-term outcome /
- National Institutes of Health Stroke Scale /
- Neurological improvement /
- Acute phase

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表 1 匹配前后2组缺血性脑卒中患者一般资料比较[例(%)]

项目	未匹配				匹配后
项目	显著提高组(n=131)	未显著提高组(n=116)	统计量	P值	显著提高组(n=89)	未显著提高组(n=89)	统计量	P值
性别			2.359^a	0.125			0.028^a	0.867
男性	89(67.9)	89(76.7)			64(71.9)	65(73.0)
女性	42(32.1)	27(23.3)			25(28.1)	24(27.0)
年龄			2.904^b	0.407			4.378^b	0.223
<50岁	13(9.9)	5(4.3)			5(5.6)	5(5.6)
50~60岁	28(21.4)	26(22.4)			13(14.6)	23(25.8)
60~70岁	56(42.7)	54(46.6)			41(46.1)	40(44.9)
≥70岁	34(26.0)	31(26.7)			30(33.7)	21(23.6)
婚姻			0.898^a	0.343			<0.001^a	0.999
已婚	119(90.8)	101(87.1)			79(88.8)	79(88.8)
其他	12(9.2)	15(12.9)			10(11.2)	10(11.2)
职业			1.847^a	0.174			0.867^a	0.172
在职	24(18.3)	14(12.1)			8(9.0)	14(15.7)
退休	107(81.7)	102(87.9)			81(91.0)	75(84.3)
教育程度			2.441^b	0.486			0.262^b	0.794
小学及以下	13(9.9)	11(9.5)			11(12.4)	10(11.2)
初中	53(40.5)	55(47.4)			38(42.7)	39(43.8)
高中	31(23.7)	29(25.0)			21(23.6)	23(25.8)
专科及以上	34(25.9)	21(18.1)			18(20.2)	18(20.2)
医保	120(91.6)	99(85.3)	2.397^a	0.122	79(88.8)	72(80.9)	2.447^a	0.118
注：^a为χ²值，^b为Z值。

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表 2 匹配前后2组缺血性脑卒中患者疾病资料比较

项目	未匹配				匹配后
项目	显著提高组(n=131)	未显著提高组(n=116)	统计量	P值	显著提高组(n=89)	未显著提高组(n=89)	统计量	P值
入院NIHSS[M(P₂₅, P₇₅)，分]	7.0(5.0，9.0)	8.0(6.3，9.0)	2.501^a	0.012	8.0(6.0, 10.0)	8.0(6.0，9.0)	0.484^a	0.628
出院NIHSS[M(P₂₅, P₇₅)，分]	2.0(1.0, 3.0)	5.0(4.0, 7.0)	10.477^a	<0.001	3.0(2.0，4.0)	5.0(4.0，6.5)	8.033^a	<0.001
mRs[M(P₂₅, P₇₅)，分]	3.0(2.0, 4.0)	3.0(3.0，4.0)	2.996^a	0.003	3.0(2.0, 4.0)	3.0(3.0，4.0)	0.720^a	0.471
MBI[M(P₂₅, P₇₅)，分]	70.0(45.0, 80.0)	60.0(50.0, 70.0)	2.030^a	0.042	60.0(45.0，75.0)	60.0(47.5, 72.5)	0.280^a	0.779
吸烟[例(%)]	62(47. 3)	64(55.2)	1.515^b	0.218	49(55.1)	47(52.8)	0.090^b	0.764
喝酒[例(%)]	48(36.6)	38(32.8)	0.409^b	0.523	39(43.8)	30(33.7)	1.917^b	0.166
睡眠时长[例(%)]			9.486^a	0.009			2.794^a	0.005
<6 h	25(19.1)	11(9.48)			17(19.1)	7(7.9)
6~7 h	48(36.6)	32(27.59)			34(38.2)	27(30.3)
>7 h	58(44.3)	73(62.93)			38(42.70)	55(61.8)
发病至就诊时间[例(%)]			1.029^a	0.794			0.961^a	0.337
≤12 h	52(39.7)	46(39.7)			40(44.9)	36(40.4)
12~24 h	19(14.5)	15(12.9)			12(13.5)	13(14.6)
1~7 d	40(30.5)	32(27.6)			28(31.5)	23(25.8)
>7 d	20(15.3)	23(19.8)			9(10.1)	17(19.1)
高血压[例(%)]	82(62.6)	85(73.3)	3.205^b	0.073	62(69.7)	66(74.2)	0.445^b	0.505
冠心病[例(%)]	13(9.9)	11(9.5)	0.014^b	0.907	12(13.5)	9(10.1)	0.830^b	0.362
房颤[例(%)]	4(3.1)	7(6.0)	1.285^b	0.257	3(3.4)	7(7.9)	0.117^b	0.732
高血脂[例(%)]	18(13.7)	17(14.7)	0.042^b	0.837	14(15.7)	17(19.1)	0.352^b	0.553
TIA史[例(%)]	11(8.4)	7(6.0)	0.508^b	0.476	5(5.6)	6(6.7)	0.872^b	0.350
糖尿病[例(%)]	34(25.9)	46(39.7)	3.590^b	0.058	26(29.2)	42(47.2)	6.092^b	0.014
MoCA(认知障碍)[例(%)]	79(60.3)	106(91.4)	31.598^b	<0.001	59(66.3)	81(91.1)	16.194^b	<0.001
PHQ-9[例(%)]			0.348^b	0.840			0.521^b	0.771
0~4分	100(76.3)	91(78.4)			21(23.6)	25(28.1)
>4分	31(23.7)	25(21.6)			68(76.4)	64(71.9)
注：^a为Z值，^b为χ²值。

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表 3 影响缺血性脑卒中患者神经功能改善的logistic回归分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
睡眠时长	0.511	0.239	4.558	0.033	1.667	1.043~2.664
糖尿病	0.516	0.336	2.356	0.125	1.675	0.867~3.238
MoCA	1.547	0.443	12.213	<0.001	4.697	1.973~11.185

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参考文献(21)

[1]	ZHOU M, WANG H, ZENG X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the global burden of disease study 2017[J]. Lancet, 2019, 394(10204): 1145-1158. doi: 10.1016/S0140-6736(19)30427-1
[2]	WANG W, JIANG B, SUN H, et al. Prevalence, incidence, and mortality of stroke in China: Results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8): 759-771. doi: 10.1161/CIRCULATIONAHA.116.025250
[3]	罗国英, 陈秀芳. 危机管理结合无缝隙一体化急救模式在急性缺血性脑卒中患者中的应用[J]. 中华全科医学, 2020, 18(11): 1936-1939. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202011039.htm
[4]	CAI Y, WANG C, DI W, et al. Correlation between blood glucose variability and the risk of death in patients with severe acute stroke[J]. Rev Neurol (Paris), 2020, 176(7-8): 582-586. doi: 10.1016/j.neurol.2019.12.003
[5]	SANDSET E C, APPLETON J P, BERGE E, et al. Associations between change in blood pressure and functional outcome, early events and death: Results from the efficacy of nitric oxide in stroke trial[J]. J Hypertens, 2019, 37(10): 2104-2109. doi: 10.1097/HJH.0000000000002154
[6]	李梅, 郑眉光, 闫振文. 急性缺血性脑卒中患者血清腱糖蛋白C和鸢尾素水平的变化及对患者预后的评估价值[J]. 中国医药, 2020, 15(11): 1714-1718. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202011015.htm
[7]	张余辉, 黄秋丽, 苏庆杰, 等. 血清蛋白质Z水平及FG79A基因多态性与急性缺血性脑卒中的关系[J]. 中华全科医学, 2020, 18(9): 1452-1484. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202009007.htm
[8]	彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004
[9]	LIAO X, ZUO L, PAN Y, et al. Screening for cognitive impairment with the montreal cognitive assessment at six months after stroke and transient ischemic attack[J]. Neurol Res, 2021, 43(1): 15-21. doi: 10.1080/01616412.2020.1819070
[10]	全国第四届脑血管病学术会议. 脑卒中患者临床神经功能缺损程度评分标准(1995)[J]. 中华神经科杂志, 1996, 29(6): 381-383. doi: 10.3760/j.issn:1006-7876.1996.06.007
[11]	AUSTIN P C. Some methods of propensity-score matching had superior performance to others: Results of an empirical investigation and monte carlo simulations[J]. Biom J, 2009, 51(1): 171-184. doi: 10.1002/bimj.200810488
[12]	WU Q, TANG A, NIU S, et al. Comparison of three instruments for activity disability in acute ischemic stroke survivors[J]. Can J Neurol Sci, 2021, 48(1): 94-104. doi: 10.1017/cjn.2020.149
[13]	ALTEMIMI M T, HASHIM A R. Acute stroke in diabetes mellitus: A prospective observational study evaluating the course and short-term outcome in Basrah, Southern Iraq[J]. Cureus, 2019, 11(10): e6017. DOI: 10.7759/cureus.6017.
[14]	FUENTES B, AMARO S, LECIANA M, et al. Stroke prevention in patients with type 2 diabetes or prediabetes. Recommendations from the cerebrovascular diseases study group, Spanish society of neurology[J]. Neurdogia, 2020, 36(4): 224-233.
[15]	高和. 《国际睡眠障碍分类》(第三版)慢性失眠障碍的诊断标准[J]. 世界睡眠医学杂志, 2018, 5(5): 555-557. doi: 10.3969/j.issn.2095-7130.2018.05.015
[16]	BAYLAN S, GRIFFITHS S, GRANT N, et al. Incidence and prevalence of post-stroke insomnia: A systematic review and meta-analysis[J]. Sleep Med Rev, 2020, 49(19): 101222. DOI: 10.1016/j.smrv.2019.101222.
[17]	XIE C, ZHU R, TIAN Y, et al. Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: A meta-analysis[J]. BMJ Open, 2017, 7(12): e013983. DOI: 10.1136/bmjopen-2016-013983.
[18]	YIN J, JIN X, SHAN Z, et al. Relationship of sleep duration with all-cause mortality and cardiovascular events: A systematic review and dose-response meta-analysis of prospective cohort studies[J]. J Am Heart Assoc, 2017, 6(9): 1-15.
[19]	王卫华, 崔时贝, 纪晓雯, 等. 睡眠时长与脑卒中及其危险因素间关系的研究进展[J]. 中国全科医学, 2019, 22(31): 3897-3901. doi: 10.12114/j.issn.1007-9572.2019.00.631
[20]	MAGGIO M G, LATELLA D, MARESCA G, et al. Virtual reality and cognitive rehabilitation in people with stroke: An overview[J]. J Neurosci Nurs, 2019, 51(2): 101-105. doi: 10.1097/JNN.0000000000000423
[21]	ABGOTTSPON S, STEINER L, SLAVOVA N, et al. Relationship between motor abilities and executive functions in patients after pediatric stroke[J]. Appl Neuropsychol Child, 2021, 5(27): 1-11.