同型半胱氨酸水平与阿替普酶静脉溶栓治疗后急性缺血性脑卒中患者神经功能恢复的关系  

Association between homocysteine level and neurological functional recovery in patients with acute ischemic stroke treated by intravenous thrombolysis using alteplase

作　　者：黄辉 吴迪 孙辉[1] 钱伟东[1] Huang Hui;Wu Di;Sun Hui;Qian Wei-dong(Department of Neurology,First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China;Department of Neurology,Linquan County People’s Hospital,Fuyang 236400,China;Department of Neurology,Eastern Theater Command General Hospital,Nanjing 210018,China)

机构地区：[1]蚌埠医学院第一附属医院神经内科,蚌埠233000 [2]临泉县人民医院神经内科,阜阳236400 [3]东部战区总医院神经内科,南京210018

出　　处：《中国药物应用与监测》2025年第1期1-4,共4页Chinese Journal of Drug Application and Monitoring

基　　金：蚌埠医学院自然科学重点项目(2021byzd152)。

摘　　要：目的探讨同型半胱氨酸(Hcy)水平与接受注射用阿替普酶(rt-PA)静脉溶栓治疗后急性缺血性脑卒中(AIS)患者神经功能恢复的关系。方法纳入2021年1月至2022年7月于蚌埠医学院第一附属医院治疗的100例AIS患者,所有患者均采用rt-PA静脉溶栓治疗。根据入院时Hcy水平,将患者分为正常水平组(Hcy水平<15.0μmol·L^(-1),43例)与高水平组(Hcy水平≥15.0μmol·L^(-1),57例)。治疗3个月后,比较两组美国国立卫生研究院卒中量表(NIHSS)以及改良Rankin量表(mRS)评分,并经Pearson相关系数分析Hcy水平与NIHSS、mRS评分之间的相关性。结果两组患者的叶酸和维生素B12水平差异有统计学意义(t=8.508、10.315,均P<0.05)。治疗前,两组NIHSS评分差异无统计学意义(P>0.05);治疗12 h后、出院时以及出院3个月时,两组的NIHSS评分均较治疗前降低,且正常水平组[分别为(11.35±2.41)分、(7.70±1.82)分、(5.63±1.43)分]均低于高水平组[分别为(14.79±2.27)分、(11.05±2.42)分、(8.93±2.35)分](t=7.306、7.597、8.136,均P<0.05)。治疗前,两组mRS评分差异无统计学意义(P>0.05);出院3个月后,正常水平组中的mRS评分≤2分的患者占比较高水平组更多,差异有统计学意义(χ^(2)=5.017,P=0.025)。Hcy水平与NIHSS评分(r^(2)=0.516,P<0.001)、mRS评分(r^(2)=0.603,P<0.001)呈正相关。结论当Hcy水平≥15.0μmol·L^(-1)时,AIS患者接受rt-PA静脉溶栓后的神经功能预后较差,需引起临床的关注。Objective To explore the correlation between neurological recovery and homocysteine(Hcy)levels in acute ischemic stroke(AIS)patients undergoing intravenous thrombolysis with alteplase(rt-PA).Methods A total of 100 AIS patients receiving rt-PA intravenous thrombolysis in the First Affiliated Hospital of Bengbu Medical College between January 2021 and July 2022 were included in this study.The patients were divided into a normal level group(Hcy level<15.0μmol·L^(-1),n=43)and a high level group(Hcy level≥15.0μmol·L^(-1),n=57)according to their Hcy levels at admission.After treatment for three months,the National Institutes of Health Stroke Scale(NIHSS)and Modified Rankin Scale(mRS)scores of the two groups were compared,and the association of Hcy levels and NIHSS and mRS scores was analyzed using the Pearson coefficient.Results There were statistically significant differences in folic acid and vitamin B12 levels between the two groups(t=8.508,10.315,both P<0.05).Before treatment,the NIHSS scores did not differ significantly between the two groups(P>0.05).Compared with those before treatment,NIHSS scores decreased at 12 hours after treatment,at discharge,and at 3 months after onset in both groups,and they were lower in the normal level group((11.35±2.41)points,(7.70±1.82)points,(5.63±1.43)points)than in the high level group((14.79±2.27)points,(11.05±2.42)points,(8.93±2.35)points)(t=7.306,7.597,8.136,all P<0.05).Before treatment,no significant difference in mRS score was observed in both groups(P>0.05).Compared with the high-level group,the normal-level group accounted for more patients with mRS score≤2 points 3 months after onset,and the difference was statistically significant(χ^(2)=5.017,P=0.025).Hcy levels were positively correlated with NIHSS scores(r^(2)=0.516,P<0.001)and mRS scores(r^(2)=0.603,P<0.001).Conclusion In acute ischemic stroke patients with Hcy levels≥15.0μmol·L^(-1),the neurological prognosis is poorer and requires attention after intravenous thrombolysis with alteplase.

关 键 词：急性缺血性脑卒中 同型半胱氨酸 阿替普酶 静脉溶栓 神经功能恢复 相关性分析 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]