老年前循环轻型急性缺血性卒中预后影响因素分析

doi:10.3969/j.issn.1673-5765.2026.06.011

摘要/Abstract

摘要： 目的探究影响老年前循环轻型急性缺血性卒中（acute ischemic stroke，AIS）患者6个月预后结局的危险因素。
方法前瞻性连续收集2023年10月—2024年6月于唐山市工人医院神经内科住院的老年（≥60岁）前循环轻型（入院时NIHSS评分≤5分）AIS患者的临床资料，包括人口学信息、既往病史、个人史、入院时实验室检查结果、入院时NIHSS评分、发病到入院时间、最大颈动脉斑块长径、颈动脉内-中膜厚度（carotid intima-media thickness，cIMT）、最大颈动脉斑块面积、斑块回声性质，以及随访6个月时的mRS评分。根据随访6个月时的mRS评分将患者分为预后良好（mRS评分0～2分）组和预后不良（mRS评分≥3分）组。比较两组的临床资料，对影响结局的指标进行多因素logistic回归分析，并采用ROC曲线评估独立危险因素对患者6个月结局的预测效能。
结果共纳入140例患者，其中预后良好组100例，预后不良组40例。单因素分析显示，预后不良组的最大颈动脉斑块长径[（15.79±8.43）mm vs.（12.02±6.17）mm，P=0.004]、cIMT[2.85（2.33～3.55）mm vs. 2.50（2.10～3.00）mm，P=0.014]、最大颈动脉斑块面积[41.90（28.77～66.92）mm2 vs. 27.29（17.46～42.57）mm2，P=0.003]均大于预后良好组，入院时NIHSS评分[5.0（4.0～5.0）分 vs. 3.0（2.0～4.0）分，P＜0.001]和低回声斑块发生率[36/40（90.0%）vs. 58/100（58.0%），P＜0.001]均高于预后良好组。多因素logistic回归分析显示，入院时NIHSS评分高（OR 3.071，95%CI 1.947～4.845，P＜0.001）、cIMT增厚（OR 1.681，95%CI 1.042～2.711，P=0.033）、存在低回声斑块（OR 4.105，95%CI 1.117～15.088，P=0.033）是预后不良的独立危险因素。
结论入院时NIHSS评分高、入院时颈动脉彩色多普勒超声显示为低回声斑块及cIMT增厚是老年前循环轻型AIS患者6个月预后不良的独立危险因素。

文章导读： 本研究联合颈动脉超声指标，证实颈动脉内-中膜增厚、低回声易损斑块共同影响老年前循环轻型卒中患者远期预后，完善了轻型卒中的风险分层体系。

关键词: 颈动脉斑块; 前循环轻型急性缺血性卒中; 预后; 危险因素

Abstract: Objective To investigate the risk factors of 6-month prognosis in elderly patients with anterior circulation minor acute ischemic stroke (AIS).
Methods Clinical data were prospectively and continuously collected from elderly patients (aged≥60 years) with anterior circulation minor AIS (defined as an admission NIHSS score≤5) hospitalized in the Department of Neurology, Tangshan Gongren Hospital from October 2023 to June 2024. Data included demographic information, medical history, personal history, laboratory test results at admission, admission NIHSS score, time from onset to admission, maximum carotid plaque length, carotid intima-media thickness (cIMT), maximum carotid plaque area, plaque echogenicity, and the mRS score at the 6-month follow-up. Patients were divided into a favorable prognosis group (mRS score 0-2) and an unfavorable prognosis group (mRS score≥3) based on the mRS score at the 6-month follow-up. Clinical data were compared between the two groups. Multivariate logistic regression analysis was performed to identify factors influencing the outcome, and ROC curves were used to evaluate the predictive efficacy of independent risk factors for the 6-month outcome.
Results A total of 140 patients were included, with 100 in the favorable prognosis group and 40 in the unfavorable prognosis group. Univariate analysis showed that the maximum carotid plaque length [(15.79±8.43) mm vs. (12.02±6.17) mm, P=0.004], cIMT [2.85 (2.33-3.55) mm vs. 2.50 (2.10-3.00) mm, P=0.014], and the maximum carotid plaque area [41.90 (28.77-66.92) mm2 vs. 27.29 (17.46-42.57) mm2, P=0.003] were significantly greater in the unfavorable prognosis group than in the favorable prognosis group. In addition, the admission NIHSS score [5.0 (4.0-5.0) points vs. 3.0 (2.0-4.0) points, P＜0.001] and the incidence of hypoechoic plaque [36/40 (90.0%) vs. 58/100 (58.0%), P＜0.001] were higher in the unfavorable prognosis group than in the favorable prognosis group. Multivariate logistic regression analysis showed that a high admission NIHSS score (OR 3.071, 95%CI 1.947-4.845, P＜0.001), increased cIMT (OR 1.681, 95%CI 1.042-2.711, P=0.033), and the presence of hypoechoic plaque (OR 4.105, 95%CI 1.117-15.088, P=0.033) were independent risk factors for unfavorable prognosis.
Conclusions A high admission NIHSS score, hypoechoic plaque on admission carotid color Doppler ultrasonography, and increased cIMT are independent risk factors for unfavorable prognosis at 6 months in elderly patients with anterior circulation minor AIS.

Key words: Carotid plaque; Anterior circulation minor acute ischemic stroke; Prognosis; Risk factor

中图分类号:

孔祥慧, 樊雅妮, 韩德昌, 李光民, 卢雅丹, 刘玉兰, 陈丽丽. 老年前循环轻型急性缺血性卒中预后影响因素分析[J]. 中国卒中杂志, 2026, 21(6): 740-745.

KONG Xianghui, FAN Yani, HAN Dechang, LI Guangmin, LU Yadan, LIU Yulan, CHEN Lili. Analysis of Prognostic Factors in Elderly Patients with Anterior Circulation Minor Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2026, 21(6): 740-745.

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链接本文: https://www.chinastroke.org.cn/CN/10.3969/j.issn.1673-5765.2026.06.011

https://www.chinastroke.org.cn/CN/Y2026/V21/I6/740

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