老年脑卒中患者继发肩手综合征的危险因素分析

Analysis of risk factors for secondary shoulder-hand syndrome in elderly stroke patients

摘要:

目的 探讨老年脑卒中患者继发肩手综合征（SHS）的危险因素。方法 采用回顾性研究方法，选取2022年1月—2024年12月在徐州市中心医院康复科住院治疗的120例老年脑卒中患者作为研究对象，根据患者是否继发SHS分为SHS组（42例）与非SHS组（78例）。比较两组患者的临床资料和实验室指标，分析老年脑卒中患者继发SHS的影响因素，绘制受试者工作特征（ROC）曲线分析血清降钙素基因相关肽（CGRP）、缓激肽（BK）及预测模型预测SHS发生的价值。结果 SHS组与非SHS组性别、年龄、病变侧别、卒中类型、高血压、糖尿病、体质量指数、偏瘫侧感觉障碍、错误的运动模式、患侧上肢静脉输液及早期良肢位摆放比较，差异均无统计学意义（P >0.05）。SHS组Brunnstrom分期Ⅰ、Ⅱ期构成、肩关节半脱位率、手水肿率、CGRP水平及BK水平均高于非SHS组（P <0.05）。Brunnstrom分期为Ⅰ、Ⅱ期［O^R =2.218（95% CI：1.295，3.799）］、肩关节半脱位［O^R =2.651（95% CI：1.306，5.381）］、手水肿［O^R =2.053（95% CI：1.217，3.463）］、CGRP水平高［O^R =1.981（95% CI：1.228，3.196）］及BK水平高［O^R =1.957（95% CI：1.183，3.237）］均为老年脑卒中患者继发SHS的危险因素（P <0.05）。ROC曲线分析结果显示，CGRP、BK及风险预测模型预测SHS发生的曲线下面积分别为0.846（95% CI：0.782，0.909）、0.773（95% CI：0.686，0.860）、0.896（95% CI：0.850，0.942），敏感性分别为78.57%（95% CI：0.683，0.895）、73.81%（95% CI：0.615，0.862）、85.71%（95% CI：0.722，0.914），特异性分别为82.05%（95% CI：0.652，0.892）、79.49%（95% CI：0.633，0.847）、87.18%（95% CI：0.685，0.908）。结论 肩关节半脱位、Brunnstrom分期弛缓期（Ⅰ、Ⅱ期）、手水肿，以及血清CGRP、BK水平升高均是老年脑卒中患者继发SHS的独立危险因素，基于以上危险因素构建的预测模型对老年脑卒中患者继发SHS具有较好的预测价值。

Abstract:

Objective To explore the risk factors of secondary shoulder-hand syndrome in elderly stroke patients.Methods A retrospective study was conducted. Elderly stroke patients who were hospitalized in the Rehabilitation Department of Xuzhou Central Hospital from January 2022 to December 2024 were selected as the research subjects. They were divided into the SHS group (n = 42) and the non-SHS group (n = 78) according to whether they developed secondary SHS.Compare the clinical data and laboratory indicators of the two groups of patients; To analyze the influencing factors of secondary SHS in elderly stroke patients, the receiver operating characteristic (ROC) curve was used to analyze the value of serum calcitonin gene-related peptide (CGRP), bradykinin (BK) and predictive models in predicting the occurrence of SHS.Results The comparisons of gender composition, age composition, lesion side composition, stroke type composition, prevalence of hypertension, prevalence of diabetes, body mass index composition, rate of sensory disturbance on the affected side, rate of incorrect movement patterns, rate of upper limb intravenous infusion on the affected side, and rate of incorrect movement patterns between the SHS group and the non-SHS group, after performing the χ² test, showed no statistically significant differences (P > 0.05).The comparison between the SHS group and the non-Brunnstrom stage group in terms of the composition of stages, the rate of shoulder subluxation, the rate of hand edema, the level of CGRP, and the level of BK showed statistically significant differences (P < 0.05).The SHS group had higher rates of Brunnstrom stage Ⅰ, Ⅱ, shoulder joint subluxation, hand edema, CGRP level, and BK level compared to the non-SHS group. The Brunnstrom stage being Ⅰ, Ⅱ [O^R = 2.218 (95% CI: 1.295, 3.799) ], shoulder joint subluxation [O^R = 2.651 (95% CI: 1.306, 5.381) ], hand edema [O^R = 2.053 (95% CI: 1.217, 3.463) ], high CGRP level [O^R = 1.981 (95% CI: 1.228, 3.196) ], and high BK level [O^R = 1.957 (95% CI: 1.183, 3.237) ] were all risk factors for secondary SHS in elderly stroke patients (P < 0.05). Through ROC analysis, the areas under the curve for CGRP, BK and the risk prediction model in predicting the occurrence of SHS were 0.846 (95% CI: 0.782, 0.909), 0.773 (95% CI: 0.686, 0.860), and 0.896 (95% CI: 0.850, 0.942), respectively. The sensitivities were 78.57% (95% CI: 0.683, 0.895), 73.81% (95% CI: 0.615, 0.862), and 85.71% (95% CI: 0.722, 0.914), and the specificities were 82.05% (95% CI: 0.652, 0.892), 79.49% (95% CI: 0.633, 0.847), and 87.18% (95% CI: 0.685, 0.908), respectively.Conclusion Shoulder subluxation, Brunnstrom stage of relaxation, hand edema, and elevated levels of serum CGRP and BK are independent risk factors for secondary SHS in elderly stroke patients. The predictive model constructed based on the above risk factors has a good predictive value for secondary SHS in elderly stroke patients.