脑白质疏松对急性轻中型脑梗死静脉溶栓疗效的影响  

Impact of leukoaraiosis on the curative effect of intravenous thrombolysis in acute mild-to-moderate cerebral infarction

作　　者：林凌 蒋柳结 王晓刚 李智 谢梓群 Lin Ling;Jiang Liujie;Wang Xiaogang;Li Zhi;Xie Ziqun(Department of Neurology,Guidong People's Hospital,Guangxi Zhuang Autonomous Region,Wuzhou 543000,China;Department of Science and Education,Guidong People's Hospital,Guangxi Zhuang Autonomous Region,Wuzhou 543000,China;Imaging Department,Guidong People's Hospital,Guangxi Zhuang Autonomous Region,Wuzhou 543000,China)

机构地区：[1]广西壮族自治区桂东人民医院神经内科,梧州543000 [2]广西壮族自治区桂东人民医院科教科,梧州543000 [3]广西壮族自治区桂东人民医院影像科,梧州543000

出　　处：《心脑血管病防治》2023年第7期32-36,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：贺州市科学研究与技术开发计划项目(20033)。

摘　　要：目的探讨脑白质疏松(LA)对急性轻中型脑梗死患者静脉溶栓出血转化、脑卒中复发及预后的影响。方法收集2020年6月至2021年12月就诊于桂东人民医院神经内科的急性轻中型脑梗死接受静脉溶栓患者161例,用Fazekas量表对LA评分,分为中-重度LA组和无-轻度LA组,比较两组的一般资料和临床资料。电话随访患者90 d预后,用90 d改良Rankin量表(mRS)评估预后,分为预后良好组和预后不良组,分析LA对急性轻中型脑梗死溶栓的影响。结果在161例脑梗死患者中,中-重度LA组107例,无-轻度LA组54例,两组患者出血转化率差异无统计学意义(χ^(2)=0.171,P>0.05)。两组患者年龄、既往脑卒中史、高血压病史、冠心病、总胆固醇、低密度脂蛋白、复发、90 d mRS评分差异均有统计学意义(t/χ^(2)=-4.197、16.191、7.281、4.248、2.240、2.004、8.420、4.024,P<0.05)。90 d随访发现,预后不良组47例,预后良好组114例。单因素分析结果显示,预后不良组心房颤动更多(χ^(2)=3.930,P<0.05)、基线美国国立卫生研究院卒中量表(NIHSS)评分更高(Z=-3.208,P<0.05),Fazekas评分更高(t=-2.548,P<0.05)及7 d NIHSS评分更高(Z=-7.453,P<0.05),Logistic回归分析显示Fazekas评分和7 d NIHSS评分是影响静脉溶栓90 d预后的影响因素[OR(95%CI)=1.409(1.007~1.972)、1.649(1.398~1.945),P<0.05]。结论LA和溶栓后7 d NIHSS评分可能是急性轻中型脑梗死静脉溶栓预后不良的独立预测因素。Objective To explore the impact of leukoaraiosis(LA)on hemorrhagic transformation,stroke recurrence and prognosis of acute mild-to-moderate cerebral infarction after intravenous thrombolysis.Methods A total of 161 patients with acute mild-to-moderate cerebral infarction who received intravenous thrombolysis in Guidong People's Hospital from June 2020 to December 2022 were recruited and divided into moderate-severe LA group and none-mild LA group based on the LA score of Fazekas scale.General and clinical data of 2 groups were compared.The 90-day modified Rankin Scale(mRS)was used to evaluate the 90-day prognosis by telephone follow-up,and the patients were divided into good prognosis group and poor prognosis group to analyze the effect of LA on thrombolysis in acute mild-to-moderate cerebral infarction.Results Out of the 161 patients with cerebral infarction,107 were classified in the moderate-severe LA group and 54 in the none-mild LA group.There was no significant difference in the bleeding conversion rate between the two groups(χ^(2)=0.171,P>0.05).Differences in age,previous stroke history,history of hypertension,coronary heart disease,cholesterol,low-density lipoprotein,the proportion of recurrence and mRs score after 90 days between the two groups were statistically significant(t/χ^(2)=-4.197,16.191,7.281,4.248,2.240,2.004,8.420,4.024;P<0.05).After 90-day follow-up,there were 47 cases in the poor prognosis group and 114 cases in the good prognosis group. Univariate analysis showed that the poor prognosis group had more atrial fibrillation (χ^(2)=3.930, P < 0.05), higher baseline National Institutes of Health Stroke Scale (NIHSS) score (Z=-3.208, P < 0.05), higher Fazekas score (t=-2.548, P < 0.05) and higher 7-day NIHSS score (Z=-7.453, P < 0.05). Logistic regression analysis showed that Fazekas score (OR=1.409, 95%CI=1.007 -1.972, P < 0.05) and 7-day NIHSS score (OR=1.649, 95%CI=1.398-1.945, P < 0.05) were independent risk factors affecting the 90-day prognosis of intravenous thrombolysis. Conclusion LA

关 键 词：急性脑梗死 白质疏松 静脉溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]