周希諴Chou Hsi-Hsien孫明輝Sun Ming-Hui醫學研究所2026-10-282003-07-022003https://handle.ncl.edu.tw/11296/jvxz9fhttps://scholars.csmu.edu.tw/handle/123456789/35003研究背景與目的： 缺血性腦中風急性期的病程常常不穩定；有相當比率的病人在住院後，其神經學症狀仍會持續惡化，常引起臨床照護上莫大的困擾。目前對於神經學症狀惡化的機轉與危險因子仍不清楚，相關的文獻很少。急性期體溫升高已知與缺血性腦中風預後不良有關，但它是否也是發生神經症狀惡化的預測因子目前並無定論。本研究主要的目的在於探討到院時體溫升高是否可以預測急性缺血性腦中風病人在住院後發生神經學症狀惡化；同時也研究是否還有其它可能的預測因子。 材料與方法： 這是一個以醫院為基礎的歷史世代研究。我們研究於1999年10月至2002年6月期間，因第一次發作急性缺血性腦中風，發病時間未滿36小時，到院時的神經學症狀及體溫記錄清楚的患者共273人。病人依據到院的體溫，腋溫37℃以上者為體溫過高組，37℃（含）以下者為體溫正常組。住院時的神經症狀嚴重度以NIH中風量表（NIHSS）表示。中風的病因診斷依TOAST分類區分為各種中風亞型。病人於住院3日之內，發生中風症狀進展相當於NIHSS分數提高2分（含）以上者定義為有神經學症狀惡化（neurological deterioration）。體溫升高與神經學症狀惡化的關聯以相對危險（relative risk）表示。另外，我們比較所有曾發生神經學症狀惡化者與未發生惡化的病人之間，其它可能的危險因子的差異。單變項分析依資料性質採用Chi-Square test，Student’s t test或Mann-Whitney U test。最後，將所有可能有關的預測因子和可能干擾因子納入logistic regression模型做多變項分析。 結果： 44位（16.1﹪）患者住院時的體溫＞37℃。體溫升高組與體溫正常組兩者的基本資料的分佈除了收縮壓以及發生季節在夏季以外，其餘並無明顯不同。總共有39位（14.3%）病人在住院後發生神經學症狀惡化。體溫升高組中有25% (11/44)發生神經學症狀惡化，正常體溫組則只有12.2% (28/229)，相對危險比為2.05 (95% 信賴區間 1.10∼3.79)。單變項分析顯示發生神經學症狀惡化的危險因子除體溫升高之外，還包括NIHSS＞7分，血糖＞126 mg/dl，白血球＞9000/μl，白蛋白＜3.5 g/dl以及TOAST診斷分類。在各缺血性中風亞型中，以大血管粥狀硬化發生症狀惡化的比率較高。多變項統計結果有統計意義的預測因子為體溫＞37℃，NIHSS＞7分，年齡較高以及TOAST診斷分類。血糖＞126 mg/dl只有臨界的相關。在控制了其它因子之後，體溫＞37℃的勝算比（Odds ratio）為3.22 （95% 信賴區間 1.12∼9.25）。 結論： 住院時體溫升高（＞37℃）是急性缺血性腦中風病人發生後神經學症狀惡化的獨立預測因子，這些患者值得被更密切地觀察與照護。缺血性中風急性期嚴格控制和預防體溫升高應有其必要性。其他可能的危險因子包括中風症狀較嚴重（NIHSS大於7分），TOAST分類為大血管粥狀硬化，血糖＞126 mg/dl以及白蛋白＜3.5 g/dl；但是需要更進一步的研究來確認。Background and Purpose: The course of acute ischemic stroke is often unstable. There are a significant proportion of patients who will experience deterioration of the neurological deficit after admission. This is an important issue in clinical care of ischemic stroke. The exact mechanism and risk factors or neurological deterioration in acute ischemic stroke are still unclear and relevant literature is rare. Hyperthermia is a recognized prognostic factor for poor outcome in acute ischemic stroke, but remains a debatable issue if hyperthermia is also a risk factor for neurological deterioration in the acute stage. The aim of this study is to clarify if hyperthermia on admission can predict the occurrence of neurological deterioration in acute ischemic stroke patients and also to investigate any other possible risk factors. Materials and Methods: This is a hospital-based historical cohort study. We studied a cohort of 273 consecutive patients with first-ever acute ischemic stroke onset less than 36 hours, who were admitted to Kuang-Tien General Hospital at Sha-Lu Town, Taichung County in Taiwan, from October 1999 to June 2002. These patients had clear and adequate records of their neurological symptoms and the body temperature on arrival. According to the body temperature on admission, the patients whose axillary’s temperature > 37oC were classified as the hyperthermia group and 37oC or less as the normothermia group. The severity of neurological deficit was scored by NIH stroke scale (NIHSS) in every patient at the time of admission. The patients were further classified to various stroke subtypes by TOAST classification. “Neurological deterioration” is defined as progression of the stroke symptoms to the level of NIHSS score that increased 2 points or more within 3 days after admission. The association of the hyperthermia and neurological deterioration is presented as relative risk. Possible prognostic factors were compared between patients with neurological deterioration and who were without deterioration. Chi-Square test, Student’s t test and Mann-Whitney U test were used to test the statistic significance between groups. In addition, all probable prognostic factors and confounding factors were examined by the logistic regression Model for multivariate analysis. Results: There were 44 patients (16.1%) with body temperature greater than 37oC. The basic characteristics were a balance between hyperthermia and normothermia group except for a higher systolic BP and greater frequency in the summer season in the hyperthermia group. Totally, there were 39 (14.3%) patients who experienced neurological deterioration within 3 days. There were 25% (11/44) patients who deteriorated in the hyperthermia group while there were only 12.2% (28/229) patients in the normothermia group. The relative risk is 2.05 (95% confidence interval 1.10~3.79). Single variant analysis revealed a significant difference in the following factors: NIHSS >7, blood sugar >126 mg/dl, WBC >9000/μl, Albumin < 3.5g/dl and TOAST stroke classification. Among the various stroke subtypes, there is higher proportion of neurological deterioration in large-artery atherosclerosis. In multi-variant analysis, NIHSS>7, older age and TOAST classification reached statistical significance. Blood sugar>126 mg/dl had a borderline association. After control of the other factors, body temperature>37 oC is an independent predictive factor with odds ratio of 3.22 (95% C.I. 1.12~9.25). Conclusion: Axillary temperature of >37 oC on admission is an independent predictive factor for the occurrence of neurological deterioration in the acute ischemic stroke patient. These patients deserve more careful observation and evaluation in the acute stroke ward. It is important to control and prevent hyperthermia more vigorously in acute ischemic stroke. Other probable risk factors included higher stroke severity (NIHSS >7), stroke subtype of large-artery atherosclerosis, blood sugar>126 mg/dl and albumin<3.4 g/dl. However, further prospective studies are required to confirm these results.神經學症狀惡化缺血性腦中風體溫進行性腦中風預測因子Nuerological deteriorationIschemic StrokeBody temperatureStroke-in-evolutionProgressing strokeStroke-in-progressionPredictorthesis