缺血性脑卒中后睡眠障碍的危险因素分析及银杏二萜内酯疗效观察

Analysis of Risk Factors of Sleep Disorder after Cerebral Ischemic Stroke and Observation of Therapeutic Effect of Ginkgo Diterpene Lactone

摘要: 目的：探讨缺血性脑卒中(CIS)患者卒中后睡眠障碍(PSSD)的危险因素。探讨应用银杏二萜内酯的疗效。方法：回顾性分析122例CIS患者的临床资料，其中男60例，女62例；年龄区间40~80岁，平均65岁。根据患者的临床症状和睡眠问卷调查以及多导睡眠监测(PSG)结果判断是否发生PSSD。将其分为睡眠障碍组(45例)和无睡眠障碍组(77例)。采用单因素和多因素Logistic回归分析两组性别、年龄、丘脑梗死、糖尿病、维生素D水平、肥胖、高血压、动脉粥样硬化与PSSD的相关性。两组患者均予基础治疗，睡眠障碍组患者加用银杏二萜内酯注射液静脉滴注。结果：两组年龄、性别与PSSD发生无相关性(P > 0.05)；丘脑梗死、高血压、糖尿病、维生素D水平、肥胖、动脉粥样硬化均与PSSD的发生相关(P < 0.05)。丘脑梗死(OR: 13.500, CI: 1.340~135.983)、糖尿病(OR: 19.429, CI: 1.876~201.175)、维生素D水平(OR: 0.037, CI: 0.002~0.793)、肥胖(OR: 0.036, CI: 0.002~0.741)与PSSD发生密切相关。睡眠障碍组患者经银杏二萜内酯治疗后的肿瘤坏死因子α (TNF-α)、白介素6 (IL-6)、白介素8 (IL-8)、超敏C反应蛋白(hs-CRP)、血管紧张素II (Ang-II)、血浆黏度水平显著低于治疗前，且未发生不良反应。结论：丘脑梗死、糖尿病、维生素D水平、肥胖均是PSSD发生的独立危险因素。对于已形成睡眠障碍的患者，给予银杏二萜内酯治疗可改善炎性因子、氧化应激水平及血液流变学指标，且安全性较高。

Abstract: Objective: To explore the risk factors of post-stroke sleep disorder (PSSD) in patients with cerebral ischemic stroke (CIS) and the curative effect of ginkgo diterpene lactone. Methods: The clinical data of 122 patients with CIS were analyzed retrospectively, including 60 males and 62 females, ranging in age from 40 to 80 years (mean 65 years). The occurrence of PSSD was judged according to the clinical symptoms and sleep questionnaire and the results of polysomnography (PSG). They were divided into sleep disorder group (n = 45) and non-sleep disorder group (n = 77). Univariate and multivariate Logistic regression was used to analyze the correlation between sex, age, thalamic infarction, diabetes, vitamin D level, obesity, hypertension, atherosclerosis and PSSD in the two groups. Patients in both groups were given basic treatment, and patients in sleep disorder group were treated with ginkgo diterpene lactone injection by intravenous drip. Results: There was no correlation between age, sex and the occurrence of PSSD in the two groups (P > 0.05), but thalamic infarction, hypertension, diabetes, vitamin D level, obesity and atherosclerosis were all related to the occurrence of PSSD (P < 0.05). Thalamic infarction (OR: 13.500, CI: 1.340~135.983), diabetes mellitus (OR: 19.429, CI: 1.876~201.175), vitamin D level (OR: 0.037, CI: 0.002~0.793) and obesity (OR: 0.036, CI: 0.002~0.741) are closely related to the occurrence of PSSD. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), hypersensitive C-reactive protein (hs-CRP), angiotensin II (Ang-II) and plasma viscosity in sleep disorder group were significantly lower than those before treatment, and there were no adverse reactions. Conclusions: Thalamic infarction, diabetes, vitamin D level and obesity are independent risk factors for PSSD. For patients with sleep disorders, ginkgo diterpene lactone treatment can improve inflammatory factors, oxidative stress levels and hemorheological indexes, and the safety is higher.