特定温度模式与小动脉闭塞性缺血性卒中严重程度相关性的研究

doi:10.3969/j.issn.1673-5765.2021.01.005

摘要/Abstract

摘要：

目的探讨寒冷和温暖两种不同温度模式下，气温与小动脉闭塞性缺血性卒中严重程度的相关性。方法回顾性分析2018年1-12月于苏州大学附属第一医院神经内科住院治疗的小动脉闭塞性缺血性卒中患者的临床资料，记录患者住院当日平均温度、人口学特征、卒中严重程度（NIHSS评分）等资料，评估寒冷和温暖两种不同温度模式下卒中严重程度的影响因素。结果研究共纳入361例患者，其中温暖组179例，寒冷组182例；轻型卒中组（NIHSS≤3分）239 例，非轻型卒中组（NIHSS＞3分）122例。低温是小动脉闭塞性缺血性卒中严重程度的独立影响因素（OR 3.08，95%CI 1.52～6.24，P =0.002）。差异性检验提示存在糖尿病（OR 3.65，95%CI 1.14～11.67， P =0.029）、高危高脂血症（OR 0.24，95%CI 0.08～0.68，P =0.008）与温度模式间的交互作用。不同温度模式下，小动脉闭塞性缺血性卒中严重程度的独立影响因素也不相同。结论低温与小动脉闭塞性缺血性卒中的严重程度相关，不同温度下的小动脉闭塞性缺血性卒中的独立影响因素可能不同，在该类患者中，需根据温度情况采用针对性更强的缺血性卒中防治策略。

文章导读： 本研究对寒冷和温暖两种气温模式下小动脉闭塞性缺血性卒中患者的临床数据进行了分析，结果提示，寒冷气温可能加重此类患者的卒中严重程度，糖尿病和高危高脂血症在不同温度模式下对卒中严重程度的影响效应存在差异。

关键词: 温度模式; 小动脉闭塞; 缺血性卒中; 独立影响因素

Abstract:

Objective To investigate the association of the ambient temperature and stroke severity in patients with small artery occlusion (SAO) ischemic stroke. Methods The clinical data of SAO ischemic stroke patients who were admitted to Department of Neurology, the First Affiliated Hospital of Soochow University between January 2018 and December 2018 were retrospectively analyzed. The average temperatures on the day of admission were also recorded. The potential risk factors for stroke severity at different temperature mode (cold and warm) in these patients were analyzed. Results A total of 361 patients were included, with 179 cases in warm temperature and 182 cases in cold temperature, 239 cases with minor stroke (NIHSS≤3) and 122 cases with non-minor stroke (NIHSS>3). The cold temperature was an independent risk factor for stroke severity in SAO subtype (OR 3.08, 95%CI 1.52-6.24, P =0.002). The heterogeneity test indicated there were interactions between different risk factors of diabetes mellitus (adjusted OR 3.65, 95%CI 1.14-11.67, P =0.029) and high-risk hyperlipidaemia (adjusted OR 0.24, 95%CI 0.08-0.68, P =0.008) and temperature. The independent risk factors for stroke severity in SAO subtype at different temperature mode were also different. Conclusions Cold temperature was associated with stroke severity in patients with SAO stroke, and the risk factors for stroke severity in SAO subtype at different temperature mode were also different. So the special intervention measures should be made in such patients according to the ambient temperature.

Key words: Temperature mode; Small artery occlusion; Ischemic stroke; Independent risk factor

秦义人，郭效宁，蒋建华，王达鹏，张全全，刘美蓉，刁珊珊，李坦，赵红如，方琪. 特定温度模式与小动脉闭塞性缺血性卒中严重程度相关性的研究[J]. 中国卒中杂志, 2021, 16(01): 27-32.

QIN Yi-Ren, GUO Xiao-Ning, JIANG Jian-Hua, WANG Da-Peng, ZHANG Quan-Quan, LIU Mei-Rong, DIAO Shan-Shan LI Tan, ZHAO Hong-Ru, FANG Qi,. Association between Temperature and Stroke Severity in Patients with Small Artery Occlusion Ischemic Stroke[J]. Chinese Journal of Stroke, 2021, 16(01): 27-32.

参考文献

[1] 王拥军，李子孝，谷鸿秋，等. 中国卒中报告2019（中

文版）（1）[J]. 中国卒中杂志，2020，15（10）：1037-

1043.

[2] 巩超，金香兰. 大面积缺血性卒中的治疗进展[J]. 中

华老年心脑血管病杂志，2019，21（3）：334-336.

[3] LIAN H，RUAN Y P，LIANG R J，et al. Shortterm

effect of ambient temperature and the risk of

stroke：a systematic review and meta-analysis[J]. Int

J Environ Res Public Health，2015，12（8）：9068-

9088.

[4] 时瑞霞，武英，李云，等. 气象因素与缺血性卒中

疾病的相关性[J]. 中国老年学杂志，2019，39（19）：

4670-4673.

[5] 李景莉，李常新，李景鑫，等. 气象因素与脑梗死亚

型的相关性研究[J]. 中西医结合心脑血管病杂志，

2015，13（16）：1895-1897.

[6] ADAMS H P，BENDIXEN B H，KAPPELLE L

J，et al. Classification of subtype of acute ischemic

stroke. Definitions for use in a multicenter clinical

trial. TOAST. trial of Org 10 172 in acute stroke

treatment[J]. Stroke，1993，24（1）：35-41.

[7] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 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.

[8] FISCHER U，BAUMGARTNER A，ARNOLD M，

et al. What is a minor stroke?[J]. Stroke，2010，41（4）：

661-666.

[9] WOODHOUSE P R，KHAW K T，PLUMMER

M. Seasonal variation of blood pressure and its

relationship to ambient temperature in an elderly

population[J]. J Hypertens，1993，11（11）：1267-

1274.

[10] MONTALCINI T，GORGONE G，GAZZARUSO

C，et al. Large brachial and common carotid artery

diameter in postmenopausal women with carotid

atherosclerosis[J]. Atherosclerosis，2008，196（1）：

443-448.

[11] SHIN D W，YOON J E，HWANG H W，et al.

Numbers of stroke patients and stroke subtypes

according to highest and lowest daily temperatures

in seoul[J]. J Clin Neurol，2016，12（4）：476-481.

[12] KEATINGE W R，COLESHAW S R，COTTER F，

et al. Increases in platelet and red cell counts，blood

viscosity，and arterial pressure during mild surface

cooling[J]. Br Med J（Clin Res Ed），1984，289

（6456）：1405-1408.

[13] PETRONE L，NANNONI S，DEL BENE A，et

al. Branch atheromatous disease：a clinically

meaningful，yet unproven concept[J]. Cerebrovasc

dis，2016，41（1/2）：87-95.

[14] 刘广志，曹江慧，梅斌，等. 分支动脉粥样硬化病和

腔隙性缺血性卒中临床差异Meta分析[J]. 中国卒中

杂志，2015，10（11）：941-946.

[15] PARK M G，OH E H，KIM B K，et al. Intravenous

tissue plasminogen activator in acute branch

atheromatous disease：does it prevent early

neurological deterioration?[J/OL]. J Clin Neurosci，

2016，33：194-197[2020-06-11]. https：//doi.org/10.

1016/j.jocn.2016.04.011.

[16] CAPLAN L R. Diabetes and brain ischemia[J/OL].

Diabetes，1996，Suppl 3：S95-97[2020-06-11].

https：//doi.org/10.2337/diab.45.3.s95.