静脉溶栓治疗急性穿支动脉闭塞脑梗死的影响因素  

Analysis of influencing factors for the therapeutic efficacy of intravenous thrombolysis on acute cerebral infarction caused by perforating artery occlusion and the prognosis

作　　者：陈娜 杨海华 吴海威 范琳琳[2] CHEN Na;YANG Haihua;WU Haiwei(Department of Neurology,Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China)

机构地区：[1]首都医科大学大兴教学医院神经内科,北京市102600 [2]首都医科大学宣武医院神经内科

出　　处：《河北医药》2023年第14期2100-2105,共6页Hebei Medical Journal

基　　金：首都医科大学大兴教学医院院级课题立项项目(编号:4202213426)。

摘　　要：目的分析影响急性穿支动脉闭塞脑梗死患者静脉溶栓治疗疗效及预后的相关因素。方法收集2018年4月至2022年4月于大兴区人民医院神经内科住院的急性穿支动脉闭塞脑梗死患者资料进行回顾性分析,患者采用静脉溶栓治疗,根据其溶栓后24 h及溶栓后7 d美国国立卫生研究院卒中量表(NIHSS)评分分为有效组(n=109)和无效组(n=221);同时根据溶栓后90 d的Rankin修订量表评分(mRS)评分分为预后不良组(n=76)和预后良好组(n=254)。收集和比较2组患者基线资料、实验室指标及影像学指标等,采用单因素、多因素Logistic回归分析早期无效及短期不良预后的相关危险因素。结果本研究共收集330例患者资料,其中早期有效221例(66.97%);无效109例(33.03%)。330例患者48 h内神经功能持续性恶化26例(7.88%),2例血小板减少(0.61%);无颅内出血、皮肤黏膜、消化道出血、过敏等并发症。330例患者中溶栓后90 d的mRS评分为0~1分为254例(76.97%);mRS评分>1分为76例(23.03%)。无效组发病至静脉溶栓时间长于有效组,高密度脂蛋白胆固醇(HDL-C)水平低于有效组(P<0.05);Logistic回归分析,发病至静脉溶栓时间较长、HDL-C低表达是急性穿支动脉闭塞脑梗死患者静脉溶栓治疗无效的影响因素(P<0.05)。预后不良组治疗前NIHSS评分高于预后良好组,HDL-C水平低于预后良好组(P<0.05);Logistic回归分析,治疗前NIHSS评分较高、HDL-C低表达是急性穿支动脉闭塞脑梗死患者静脉溶栓治疗预后不良的影响因素(P<0.05)。结论急性穿支动脉闭塞脑死患者应用静脉溶栓具有一定的效果,且安全性较高,但发病至静脉溶栓时间可影响静脉溶栓治疗的疗效;治疗前NIHSS评分是影响患者静脉溶栓治疗的短期预后的因素,HDL-C是患者静脉溶栓治疗疗效和短期获得良好预后的保护性因素。Objective To analyze influencing factors for the efficacy of intravenous thrombolysis on acute cerebral infarction caused by perforating artery occlusion and the prognosis.Methods Clinical data of patients with cerebral infarction caused by perforating artery occlusion hospitalized in the Department of Neurology of Daxing District People’s Hospital from April 2018 to April 2022 were retrospectively analyzed.The patients were treated with intravenous thrombolysis,and they were divided into effective group(n=109)and ineffective group(n=221)according to the National Institutes of Health Stroke Scale(NIHSS)scores at 24 hours and 7 days after thrombolysis.Moreover,patients were divided into poor prognosis group(n=76)and good prognosis group(n=254)according to the Modified Rankin Scale(mRS)scores at 90 days after thrombolysis.Baseline data,laboratory and imaging data were compared between groups.Univariable and multivariable logistic regression analyses were performed to identify risk factors for the early-stage ineffectiveness and poor prognosis.Results Clinical data of 330 patients were collected in this study,involving 221/330(66.97%)cases of early-stage effectiveness and 109/330(33.03%)invalid cases.There were 26/330(7.88%)patients with continuously deteriorated neurological function within 48 hours and 2/330(0.61%)cases of thrombocytopenia.Intracranial hemorrhage,skin and mucous membrane bleeding,gastrointestinal hemorrhage,allergy and other complications were not reported.There were 254/330(76.97%)patients with 0-1 point of mRS at 90 d of thrombolysis,and 76/330(23.03%)with>1 point.The time from onset to intravenous thrombolysis in the ineffective group was significantly longer than that in the effective group,and the level of high-density lipoprotein cholesterol(HDL-C)was significantly lower(P<0.05).Logistic regression analysis showed that the longer time from onset to intravenous thrombolysis and the lower expression of HDL-C were risk factors for ineffective intravenous thrombolysis in patients with acute ce

关 键 词：急性穿支动脉闭塞脑梗死 静脉溶栓 疗效 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]