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作 者:杨琦 叶婷 焦宇琼 朱骏 韩翔 董强 YANG Qi;YE Ting;JIAO Yu-qiong;ZHU Jun;HAN Xiang;DONG Qiang(Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurology,Huadong Hospital,Fudan University,Shanghai 200040,China)
机构地区:[1]复旦大学附属华山医院神经内科,上海200040 [2]复旦大学附属华东医院神经内科,上海200040
出 处:《中国临床神经科学》2024年第5期536-544,共9页Chinese Journal of Clinical Neurosciences
基 金:上海市卫生健康委员会面上项目(编号:202140512);上海卒中学会神经病学研究基金(编号:SSA-2020-023);国家重点研发计划“常见多发病防治研究”(编号:2021YFC2500100);国家自然科学基金(编号:82071197)。
摘 要:目的研究多效性血液净化体外血浆脂蛋白清除系统(DELP)在静脉溶栓后未完全缓解的急性缺血性脑卒中(AIS)患者中的疗效和安全性,探索DELP对新型血脂靶点的疗效。方法本研究纳入了2020年1月至2021年12月62例在发病4.5 h时间窗内仅接受标准剂量阿替普酶静脉溶栓且溶栓后24 h神经功能未完全恢复AIS患者。根据患者接受的治疗方案进行分组:DELP组(31例),经评估符合入选标准接受静脉溶栓后进行DELP治疗;对照组(31例),未接受DELP治疗。收集DELP组治疗前后的血脂指标并计算衍生指标评价DELP的降脂效果。主要结局指标为90 d改良Rankin量表(mRS)为0~1的比例。结果经过1∶1倾向性评分匹配后,共纳入62例患者。DELP组的90 d时良好预后(mRS 0~1)比例(P=0.042)和mRS分布(P=0.021)均优于对照组。实验室检查:除显著降低胆固醇及低密度脂蛋白外,DELP治疗后非高密度脂蛋白(non-HDL)、non-HDL/HDL、载脂蛋白(Apo)B、ApoB/ApoA1与治疗前比较均显著降低(均P<0.01)。结论在最佳药物治疗基础上,DELP可以进一步改善静脉溶栓后的AIS患者临床预后,快速有效降低各类非传统血脂指标,为AIS患者提供了新的降脂治疗选择。Aim To investigate the efficacy and safety of a multi-effect blood purification therapy,the delipid extracorporeal lipoprotein filter from plasma(DELP)system,in treating acute ischemic stroke patients with incomplete recovery following intravenous thrombolysis,and evaluate the effect of DELP on non-traditional lipid profiles.Methods Sixty-two acute ischemic stroke patients admitted to Huashan Hospital from January 2020 to December 2021 were included in this study.The patients had only received standard-dose alteplase intravenous thrombolysis,and their neurological function was not fully recovered 24 h after thrombolysis.The patients were divided into two groups according to the treatment protocols they received.The DELP group was treated with DELP after intravenous thrombolysis,and those who did not receive DELP were used as the control group.The primary outcome was the proportion of patients with a 90-day modified Rankin Scale(m RS)of 0~1.In the DELP group,lipid profiles were collected and analyzed before and after DELP treatment to assess the lipid-lowering effect of DELP.Results After 1:1 propensity score matching,a total of 62 patients were included,31 in the DELP group and 31 matched patients in the control group.The DELP group had a significantly higher ratio of m RS0~1(P=0.042),and the distribution of m RS at 90 days was better in the DELP group(P=0.021)than in the control group.Laboratory tests before and after the treatment showed that DELP treatment could rapidly reduce the levels of total cholesterol,LDL,HDL,non-HDL,non-HDL/HDL,APOB and APOB/APOA1.Conclusion DELP may improve the prognosis of acute stroke patients following intravenous thrombolysis.This treatment also provides a new intensive lipid-lowering option for patients with acute ischemic stroke by rapidly reducing non-traditional lipid parameters.
关 键 词:急性缺血性脑卒中 溶栓 体外血浆脂蛋白清除 血脂
分 类 号:R743[医药卫生—神经病学与精神病学]
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