| Objective:The purpose of this study was to find independent risk factors for brain herniation in patients with acute anterior circulation massive cerebral infarction(MCI),and to evaluate the NIHSS(National institute of health stroke scale)score and the Modified Rankin Scale(Modified Rankin Scale)on admission.,mRS)score,Glasgow Outcome Scale(GOS)score,and APACHE Ⅱ score can better predict the formation of brain herniation in patients with acute anterior circulation large-area cerebral infarction,so as to facilitate early intervention and identification,and provide reference for guiding clinical work.Methods:A total of 142 patients with acute anterior circulation large-area cerebral infarction who were admitted to the Department of Neurology,Fifth Clinical School of Medicine,Shanxi Medical University from January 2021 to March 2022 were selected,and they were divided into brain herniation group(n=62)according to whether brain herniation occurred during hospitalization.and non-herniated group(n=80).Univariate analysis was used to compare the general data,laboratory test indicators,and related scores of the patients in the herniation group and the non-brain herniation group;the variables with statistical differences were subjected to multivariate Logistic regression analysis,and the acute anterior circulation large-area cerebral infarction was screened out.Independent risk factors for brain herniation in patients;and by drawing receiver operating characteristic curve(ROC)to evaluate the diagnostic efficacy of relevant clinical scores in patients with acute anterior circulation large-area cerebral infarction.Results:1.A total of 142 patients were included in this study,62 in the herniation group and 80 in the non-brain herniation group.Univariate analysis between the two groups showed that compared with the non-brain herniation group,the age(61.94±2.21vs.70.55±1.97,P=0.005),atrial fibrillation(16.1%vs.42.5%,P=0.017),mechanical thrombectomy(12.9%vs.40.0%,P=0.012),platelet count(219.35±63.70vs.164.95)±44.08^109/L,P=0.039),D-dimer(1205.94±406.643vs.727.05±258.07,P=0.002),neutrophil/lymphocyte ratio(10.69±4.20vs.7.42±2.86%),P=0.039),C-reactive protein(72.57vs.11.89,P<0.001),APACHE Ⅱscore(15.50vs.5.50,P<0.001),mRS score(5.00vs.4.00,P<0.001)differences were statistically significant Academic significance(P<0.05).2.Gender,history of cerebrovascular disease,hypertension,diabetes,smoking,drinking,intravenous thrombolysis,pulmonary infection,cerebral hemorrhage,procalcitonin,lipoprotein phospholipase A2,homocysteine,low density lipoprotein,There was no significant difference in NIHSS score and Glasgow score between the two groups(P>0.05).3.Binary multivariate Logistic regression analysis showed:neutrophil to lymphocyte ratio(NLR)(P=0.020,OR=1.375),C-reactive protein(CRP)(P=0.005,OR=1.058),platelet count(Plt)(P=0.012,OR=1.023),D-dimer(P=0.003,OR=1.003)were patients with acute anterior circulation massive cerebral infarction The risk factors of brain herniation,mRS score(P=0.028,OR=0.028)and APACHA Ⅱ(P=0.017,OR=1.809)score may be able to predict brain herniation in patients with acute anterior circulation massive cerebral infarction.4.Combined with D-dimer(95%CI 0.597～0.905;P=0.003),CRP(95%CI 0.653～0.918;P=0.001),mRS score(95%CI)by receiver operating characteristic(ROC)curve 0.577-0.874;P=0.008),APACHA Ⅱ score(95%CI 0.308-0.646;P=0.086)can better predict the herniation of acute anterior circulation large-area cerebral infarction.Modified Rankin Scale(mRS)Compared with APACHA Ⅱ score,it can better predict brain herniation in patients with acute anterior circulation massive cerebral infarction(AUC0.725,95%CI 0.577-0.874;P=0.008).Conclusion:1.NLR,CRP,platelet count,D-dimer are independent risk factors for the formation of brain herniation in acute anterior circulation large area infarction.2.Combining D-dimer,CRP,mRS score and APACHA Ⅱ score can better predict herniation of acute anterior circulation large area cerebral infarction. |
