早期神经功能恶化与急性缺血性卒中患者静脉溶栓后短期转归不良的相关性分析  

Correlation between the early neurological deterioration and the poor short-term outcome after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：王维 房砚文 宫萍[2] Wang Wei;Fang Yanwen;Gong Ping(Department of Neurology,China Civil Aviation General Hospital,Beijing 100123,China;Department of Geriatric Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]民航总医院神经内科,北京100123 [2]北京大学第三医院老年病内科,北京100191

出　　处：《中国综合临床》2024年第3期179-185,共7页Clinical Medicine of China

摘　　要：目的探讨早期神经功能恶化与急性缺血性脑卒中患者重组组织型纤溶酶原激活剂(recombinant tissue Plasmin activator,rt PA)静脉溶栓后短期转归不良的相关性。方法选取2019年1月至2022年10月于民航总医院神经内科接受rt-PA静脉溶栓治疗的268例急性缺血性卒中患者的临床资料进行回顾性分析。在溶栓后14 d时应用改良Rankin量表评价短期转归,0~2分定义为转归良好组,3~5分或死亡定义为转归不良组。收集两组患者的临床、实验室及影像资料。采用单因素分析比较两组患者基线资料,采用多因素Logistic回归分析确定短期转归不良的独立危险因素。结果单因素分析结果显示,转归不良组患者年龄、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、空腹血糖、糖化血红蛋白、冠状动脉粥样硬化性心脏病(冠心病)史占比、心房颤动史占比、脑室旁高信号(3分)占比、溶栓后出血转化占比、早期神经功能恶化(early neurological deterioration,END)占比、双循环梗死占比、皮层区新发梗死占比、内囊区新发梗死占比、TOAST分型中大动脉粥样硬化型占比、TOAST分型中心源性栓塞占比均高于转归良好组[68.00(59.00,80.00)岁比64.00(54.50,72.00)岁,9(6,13)分比5(3,7)分,6.85(5.25,9.20)mmol/L比5.64(4.90,6.75)mmol/L,6.40(5.70,7.75)%比6.00(5.60,6.80)%,31.3%(31/99)比17.7%(30/169),28.3%(28/99)比9.5%(16/169),26.3%(26/99)比13.0%(22/169),19.2%(19/99)比5.9%(10/169),53.5%(53/99)比21.9%(37/169),10.1%(10/99)比2.4%(4/169),44.4%(44/99)比22.5%(38/169),41.4%(41/99)比27.8%(47/169),33.3%(33/99)%比17.8%(30/169),25.3%(25/99)比6.5%(11/169)],而转归不良组患者TOAST分型中小动脉闭塞型占比、TOAST分型中其他占比、血小板计数均低于转归良好组[29.3%(29/99)比53.8%(91/169),12.1%(12/99)比21.8%(37/169),199(163,240)×109/L比221(179,259)×109/L],差异均有统计学意义(统计量值分别为U=2.80、U=7.94、Objective To explore the correlation between the early neurological deterioration and the poor short-term outcome after intravenous thrombolysis with recombinant tissue Plasmin activator(rt PA)in patients with acute ischemic stroke.Methods A retrospective analysis of 268 patients with acute ischemic stroke who received recombinant tissue Plasmin activator(rt-PA)intravenous thrombolytic therapy in the Department of Neurology of Civil Aviation General Hospital from January 2019 to October 2022 was performed.The modified Rankin scale(mRS)was used to evaluate short-term outcome at 14 days after thrombolysis,with a score of 0 to 2 defined as good outcome and a score of 3 to 5 or death defined as poor outcome.Clinical,laboratory and imaging data of the two groups were collected.Univariate analysis was used to compare the baseline data of the two groups,and multivariate Logistic regression analysis was used to determine the independent risk factors for poor short-term outcomes.Results Univariate analysis showed that age,baseline NIHSS score,fasting blood sugar,glycated hemoglobin,the proportion of coronary heart disease,proportion of atrial fibrillation,proportion of paraventricular high signal(3 score),proportion of hemorrhage transformation,proportion of END,proportion of double circulation infarction,proportion of new cortical infarction,proportion of new internal capsule infarction,proportion of large atherosclerosis of TOAST classification,and proportion of cardiogenic embolism of TOAST classification in the good outcome group were higher than those in the poor outcome group(68.00(59.00,80.00)years old vs 64.00(54.50,72.00)years old,9(6,13)points vs 5(3,7)points,6.85(5.25,9.20)mmol/L vs 5.64(4.90,6.75)mmol/L,6.40(5.70,7.75)%vs 6.00(5.60,6.80)%,31.3%(31/99)vs 17.7%(30/169),28.3%(28/99)vs 9.5%(16/169),26.3%(26/99)vs 13.0%(22/169),19.2%(19/99)vs 5.9%(10/169),53.5%(53/99)vs 21.9%(37/169),10.1%(10/99)vs 2.4%(4/169),44.4%(44/99)vs 22.5%(38/169),41.4%(41/99)vs 27.8%(47/169),33.3%(33/99)vs 17.8%(30/169),25.3%(25/99)vs 6.5%

关 键 词：急性缺血性卒中 静脉溶栓 早期神经功能恶化 转归 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]