目的:探讨老年急性心源性脑梗死(acute cardiogenic cerebral embolism,ACCE)患者梗死面积的相关因素。

方法:回顾性收集上海市第四人民医院神经内科2018年1月1日至2021年11月30日出院的 65 岁以上的 ACCE 患者的临床资料，按磁共振弥散加权成像(diffusion weighted imaging,DWl)序列显示的梗死面积分成大、中、小面积组,对3组的临床一般资料和血化验指标的进行单因素统计分析,对差异显著的相关因素进行有序多分类loaistic 回归分析。

结果:共收集 146 例老年 ACCE 患者,其中男性 41 例、女性 105 例,分别对大、中、小梗死面积的3组进行组间单因素分析,结果提示年龄、美国国立卫生研究院神经功能缺损量表评分、格拉斯哥昏迷量表( Glasgow Coma Scale,GCS)评分、改良 Rankin 量表(modified Rankin Scale,mRS)评分、住院死亡率、血钠、血氯、血镁、超敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)、脑钠肽( brain natriuretic peptide,BNP)、D-二聚体、中性粒细胞与淋巴细胞比值(neutrophils to lymphocytes ratio,NLR)差异有统计学意义,多因素有序多分类 logistic回归分析显示,年龄[比值比为 1.062(95%置信区间:0.029~0.108):P<0.01]、NIHSS 评分[比值比为 18.139(95%置信区间:1.001~4.680):P<0.01]、hsCRP[比值比为 1.086(95%置信区间:0.027~0.138):P<0.011、BNP[比值比为 1.001(95%置信区间:0.000~0.002):P<0.011、NLR[比值比为 1.053(95%置信区间:0.000~0.111):P<0.051是老年 ACCE 患者梗死面积的独立危险因素。

结论:年龄、美国国立卫生研究院神经功能缺损量表评分、hsCRP、BNP、NLR 与老年急性心源性脑梗死患者梗死面积明显相关,hsCRP、BNP、NLR 是老年 ACCE 患者，特别是大面积脑梗死防治需要重点关注的指标。

Objective: To investigate the related factors of infarct size of elderly patients with acute cardiogenic cerebral embolism (ACCE) .

Methods:The clinical data of ACCE patients over 65 years old who were admitted to the Department of Neurology, Shanghai Fourth People's Hospital from January 1, 2018 to November 30, 2021 were retrospectively collected. The patients according to infarct area showed by diffusion weighted imaging (DWI) sequence were divided into large, medium and small infarct size groups. The univariate statistical differences of clinical general data and blood test indexes of the three groups were compared respectively. Then applied multivariate logistic regression analysis to capered those significantly different related factors. 

Results: There were 146 elderly patients with ACCE, including 41 males and 105 females.Univariate analysis between large, medium, and small size groups suggested age, National nstitute of Health Stroke Scale (NIHSS)score, Glasgow Coma Scale (GCS)score, modified Rankin Scale (mRS) score, in-hospital mortality, blood sodium ions, blood chloride ions blood magnesium ions, high-sensitivity C-reactive protein(hsCRP), brain natriuretic peptide (BNP), D-dimer, and neutrophil to lymphocyte ratio (NLR)were statistically significant Multivariate logistic regression analysis indicated age lodds ratio (OR): 1.062 (95%confidence interval: 0.029-0.108);P<0.01,NIHSS score OR:18.139 (95% confdenceinterval: 1.001-4.680); P<0.01,hsCRP (OR:1.086 (95% confdence interval: 0.027-0.138)P<0.01], BNP (OR: 1.001 (95% confidence interval: 0.000-0.002); P<0.01], and NLR [OR.1.053 (95% confidence interval: 0.000-0.111); P<0.05]were independent risk factors forinfarct size of elderly patients with ACCE. 

Conclusion: Age, NIHSS, hsCRP, BNP and NLR are significantly correlated with infarct sizeof elderly patients with ACCE. Besides, hsCRP, BNP and NLR are monitoring indicators that should be paid more attention in the prevention and treatment of ACCE in the elderly especially with large area cerebral infarction.