卒中前体育锻炼对软脑膜侧支循环及患者预后的影响

袁长红; 吴晓宇; 刘群; 张璐; 朱迎春

doi:10.16766/j.cnki.issn.1674-4152.002585

卒中前体育锻炼对软脑膜侧支循环及患者预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.002585

安徽省第二人民医院神经内科，安徽合肥 230041

基金项目:

安徽省卫生计生委科研计划项目 2018SEYL029

详细信息

通讯作者:
袁长红, E-mail: 37547794@qq.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2021-11-21
- 网络出版日期: 2022-09-26

Effect of pre-stroke physical activity on pial collateral circulation and patient prognosis

Department of Neurology, the Second People's Hospital of Anhui Province, Hefei, Anhui 230041, China

摘要

摘要: 目的探讨卒中前体育锻炼水平对急性前循环脑梗死患者软脑膜侧支循环及预后的影响。方法选取安徽省第二人民医院神经内科2017年1月—2020年6月收治住院的急性前循环脑梗死患者，采用CT血管造影(CTA)评价的区域软脑膜评分(rLMC)对患者软脑膜侧支循环进行半定量评估，采用现代Saltin-Grimby体育锻炼水平量表(SGPALS)对卒中前患者体育锻炼水平进行量化评估，采用改良Rankin评分(mRS)评估患者发病3个月生活自理能力，比较不同体育锻炼水平间患者rLMC的差异，及对90天改良mRS的影响。结果共纳入157例患者，其中低运动量组患者72例，高运动量组85例，高运动量组基线收缩压、基线NIHSS评分、发病3个月mRS评分低于低运动量组(P值分别为0.001、0.039、 < 0.001)，rLMC评分高于低运动量组(P=0.023)，差异有统计学意义；发病3个月99例患者预后良好(mRS≤2)，58例患者预后不良(mRS＞2)，预后良好组SGPALS评分高于预后不良组(P＜0.001)，rLMC评分大于预后不良组(P＜0.001)，既往他汀类药物服用率高于预后不良组(P=0.041)，差异有统计学意义；多因素logistic回归分析发现SGPALS评分及rLMC评分高是良好预后的保护性因素(OR=1.455、1.181;P=0.043、0.003)，既往糖尿病史、基线NIHSS评分高是良好预后的危险因素(OR=0.366、0.899;P=0.027、0.023)。结论卒中前体育锻炼能改善急性前循环脑梗死患者软脑膜侧支循环及发病3个月临床预后。
- 脑梗死 /
- 体育锻炼 /
- 软脑膜侧支循环
Abstract: Objective To determine the effect of pre-stroke physical activity level on pial collateral circulation and prognosis in patients with acute anterior circulation cerebral infarction. Methods Patients with acute anterior circulation cerebral infarction admitted to the Department of Neurology, rhe Second People's Hospital of Anhui Province from January 2017 to June 2020 were enrolled. The regional leptomeningeal score (rLMC) evaluated by CT angiography (CTA) was used to semi-quantitatively evaluate the patients ' pial collateral circulation. The modern Saltin-Grimby Physical Activity Level Scale (SGPALS) was used to quantitatively evaluate the physical activity level of patients before stroke. The modified Rankin Scale (mRS) score was used to assess the patients ' ability to take care of himself at 3 months onset. The difference in rLMC between patients with different physical activity levels and the effect on 90-day mRS score were compared. Results A total of 157 patients were enrolled, including 72 patients in the low exercise group and 85 patients in the high exercise group. The baseline systolic blood pressure, baseline NIHSS score and 3-month mRS score in the high exercise group were lower than those in the low exercise group (P values were 0.001, 0.039, < 0.001, respectivey), and the rLMC score was higher in the high exercise group than in the low exercise group (P=0.023). The prognosis of 99 patients was good (mRS≤2) and 58 patients was poor (mRS > 2) after 3 months onset. The SGPALS score of the good prognosis group was higher than that of the poor prognosis group (P < 0.001), and the rLMC score of the good prognosis group was higher than that of the poor prognosis group (P < 0.001). The previous statin use rate of the good prognosis group was higher than that of the poor prognosis group (P=0.041). Multivariate logistic regression analysis showed that SGPALS score and rLMC score were protective factors of good prognosis (OR=1.455, 1.181, P=0.043, 0.003, respectively). Previous diabetes history and baseline NIHSS score were unfavourable factors for good prognosis (OR=0.366, 0.899, P=0.027, 0.023, respectively). Conclusion Pre-stroke physical activity can improve the pial collateral circulation of patients with acute anterior circulation cerebral infarction and the clinical prognosis for 3 months.
- Acute stroke /
- Physical activity /
- Collateral circulation

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表 1 不同体育锻炼水平患者间资料的比较

Table 1. Comparison of data between patients with different levels of physical exercise

项目	低运动量组(SGPALS评分1~2分，n=72)	高运动量组(SGPALS评分3~4分，n=85)	统计量	P值
性别[例(%)]			0.069^a	0.792
男性	40(55.56)	49(57.65)
女性	32(44.44)	36(42.35)
年龄(x ±s，岁)	64.10±8.11	64.36±9.96	0.182^b	0.856
血管危险因素[例(%)]
吸烟史	28(38.89)	35(41.18)	0.085^a	0.771
高血压病	46(63.89)	52(61.18)	0.122^a	0.727
2型糖尿病	24(33.33)	26(30.59)	0.135^a	0.713
冠心病	8(11.11)	8(9.41)	0.132^a	0.726
心房颤动	11(15.28)	10(11.76)	0.415^a	0.519
高脂血症	32(44.44)	37(43.53)	0.170^a	0.680
发病前使用药物[例(%)]
降压药物	31(43.01)	28(32.94)	3.307^a	0.069
抗血小板药物	10(13.89)	12(14.17)	0.001^a	0.976
降糖药物	18(25.00)	18(21.18)	0.322^a	0.570
他汀类药物	13(18.06)	13(15.29)	0.215^a	0.643
入院时血压(x ±s，mm Hg)
收缩压	160.13±14.79	151.88±16.39	3.283^b	0.001
舒张压	85.46±9.42	84.09±13.78	0.711^b	0.458
基线NIHSS评分[ M(P₂₅, P₇₅)，分]	12(8, 15)	10(8, 12)	2.069^c	0.039
发病至CTA检查时间[ M(P₂₅, P₇₅)，h]	18.00(16.00, 21.75)	19.00(16.00, 22.50)	0.616^c	0.538
rLMC评分[ M(P₂₅, P₇₅)，分]	11.00(8.00, 13.75)	12.00(10.00, 16.00)	2.277^c	0.023
90天mRS评分[ M(P₂₅, P₇₅)，分]	3(2，4)	2(1，3)	3.778^c	＜0.001
注：^a为χ²值，^b为t值，^c为Z值；1 mm Hg=0.133 kPa。

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表 2 发病3个月良好预后与不良预后组间资料的比较

Table 2. Comparison of data between good and poor prognosis groups at 3 months after onset

项目	mRS≤2(n=99)	mRS＞2(n=58)	统计量	P值
SGPALS评分[ M(P₂₅, P₇₅)，分]	3(2，4)	2(1，3)	3.637^a	＜0.001
rLMC评分[ M(P₂₅, P₇₅)，分]	12(10，15)	10(7，13)	4.027^a	＜0.001
性别[例(%)]
男性	52(52.53)	37(63.79)	1.891^b	0.169
女性	47(47.47)	21(36.21)
年龄(x ±s，岁)	64.04±9.39	64.59±8.73	0.361^c	0.719
血管危险因素[例(%)]
吸烟史	36(36.36)	27(46.55)	1.580^b	0.209
高血压病	57(57.58)	41(70.69)	2.681^b	0.102
2型糖尿病	26(26.26)	24(41.38)	3.850^b	0.050
冠心病	9(9.09)	7(12.07)	0.354^b	0.552
心房颤动	15(15.15)	6(10.34)	0.729^b	0.393
高脂血症	42(42.42)	27(46.55)	0.253^b	0.615
发病前使用药物[例(%)]
降压药物	39(39.39)	20(34.48)	0.376^b	0.540
抗血小板药物	12(12.12)	10(17.24)	0.796^b	0.372
降糖药物	20(20.20)	16(27.58)	0.988^b	0.320
他汀类药物	21(21.21)	5(8.62)	4.196^b	0.041
基线NIHSS评分[ M(P₂₅, P₇₅)，分]	10.00(8.00，13.00)	12.00(8.75，15.00)	3.024^a	0.002
入院时血压(x ±s，mm Hg)
收缩压	154.03±15.69	158.16±16.68	1.573^c	0.083
舒张压	84.14±11.88	85.55±11.13	0.711^c	0.478
注：^a为Z值，^b为χ²值，^c为t值。

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表 3 影响发病3个月良好预后(mRS≤2)的多因素回归分析

Table 3. Multivariate regression analysis of good prognosis (mRS≤2) at 3 months after onset

影响因素	B	SE	Wald χ²	P值	OR(95% CI)
SGPALS评分	0.375	0.185	4.087	0.043	1.455(1.012~2.093)
rLMC评分	0.166	0.056	8.790	0.003	1.181(1.058~1.318)
2型糖尿病史	-1.005	0.455	4.880	0.027	0.366(0.150~0.893)
既往服用他汀药物	0.699	0.649	1.160	0.281	2.013(0.564~7.185)
收缩压	-0.011	0.013	0.700	0.403	0.989(0.964~1.015)
基线NIHSS评分	-0.118	0.048	6.103	0.013	0.889(0.810~0.976)
注：SGPALS评分、rLMC评分、收缩压、基线NIHSS评分均以实际值赋值；2型糖尿病史，有=1，无=0；既往服用他汀药物，有=1，无=0。

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