急性缺血性卒中静脉溶栓后早期神经功能恶化影响因素分析

doi:10.3969/j.issn.1673-5765.2021.12.010

摘要/Abstract

摘要： 目的探讨急性缺血性卒中患者静脉溶栓后早期神经功能恶化（early neurological deterioration，END）的相关因素。方法回顾性分析2020年4-9月连续住院的应用阿替普酶静脉溶栓的急性缺血性卒中患者，根据溶栓后24 h内是否发生神经功能恶化（静脉溶栓后24 h内NIHSS评分较入院时增加≥2分或死亡）分为 END组和无END组。收集两组患者的人口学信息（性别、年龄）和吸烟史；既往病史（高血压、糖尿病、高脂血症、冠心病、心房颤动、缺血性卒中史）；发病后临床资料，包括发病到溶栓时间、入院时血压、入院24 h内血压最大差值、入院时随机血糖、发病24 h内实验室检查结果（空腹血糖、糖化血红蛋白、总胆红素、直接胆红素、HDL-C、LDL-C、尿酸水平）、梗死部位（前循环和后循环）、TOAST分型、溶栓前和溶栓24 h时NIHSS评分、溶栓后24 h颅内出血等指标。采用单因素logistic回归方法比较END组和无 END组上述指标的差异，并对差异有统计学意义的指标进行多因素logistic回归分析。结果共纳入186例静脉溶栓的急性缺血性卒中患者，END组30例（16.1%），无END组156例（83.9%）。单因素logistic回归分析显示，与无END组比较，END组空腹血糖（OR 1.199，95%CI 1.051～1.367， P =0.007）和糖化血红蛋白水平更高（OR 1.401，95%CI 1.055～1.819，P =0.020），前循环梗死（OR 3.121，95%CI 1.266～7.296，P =0.013）和TOAST分型中的大动脉粥样硬化型比例更高（OR 4.365， 95%CI 1.768～10.773，P =0.001），溶栓前NIHSS评分更高（OR 1.129，95%CI 1.061～1.202，P <0.001）、溶栓后24 h颅内出血比例更高（OR 7.600，95%CI 1.910～30.244，P =0.004）；高血压病史比例更低（OR 0.417，95%CI 0.188～0.926，P =0.032）。多因素logistic回归分析显示，溶栓前高NIHSS评分（OR 1.079， 95%CI 1.004～1.164，P =0.048）是急性缺血性卒中患者静脉溶栓后END的独立危险因素，高血压病史（OR 0.392，95%CI 0.160～0.962，P =0.041）是其保护性因素。结论急性缺血性卒中患者静脉溶栓前NIHSS评分高的患者发生END的风险大，既往有高血压病史者发生END的风险相对较低。

文章导读： 静脉溶栓和未溶栓的缺血性卒中患者发生END的机制不同，危险因素也不同，本研究发现，既往高血压病史是静脉溶栓的急性缺血性卒中患者发生END的保护因素而溶栓前NIHSS较高是END的危险因素，为此类患者临床预测END提供了一定的借鉴。

关键词: 缺血性卒中; 静脉溶栓; 早期神经功能恶化; 危险因素; 高血压

Abstract: Objective To investigate the related factors of early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods The data of consecutive AIS inpatients who received intravenous thrombolysis with rt-PA from April to September, 2020 were retrospectively analyzed. According to occurring early neurological deterioration (END) (NIHSS score ≥2 points or death within 24 hours after thrombolysis) or not, all the patients were divided into END group and non-END group. The

clinical data including demographic information, baseline clinical information, laboratory tests

results and imaging results were collected. The above clinical variables between the two groups were compared, and multivariable logistic regression model was used to determine the associated factors of END. Results A total of 186 patients were included, with 30 cases (16.1%) in END group and 156 cases (83.9%) in non-END group. Compared to the non-END group, the END group had higher fasting glucose (OR 1.199, 95%CI 1.051-1.367, P =0.007), hemoglobin A1c (OR 1.401, 95%CI 1.055-1.819, P =0.020) and baseline NIHSS score (OR 1.129, 95%CI 1.061-1.202, P <0.001), higher proportion of anterior circulation infarction (OR 3.121, 95%CI 1.266-7.296, P =0.013), large atherosclerotic infarction (OR 4.365, 95%CI 1.768-10.773, P =0.001) and intracranial hemorrhage within 24 hours after thrombolysis (OR 7.600, 95%CI 1.910-30.244, P =0.004), lower proportion of hypertension (OR 0.417, 95%CI 0.188-0.926, P =0.032). Multivariate logistic regression analysis showed that baseline NIHSS was an independent risk factor of END (OR 1.079, 95%CI 1.004-1.164, P =0.048), and hypertension (OR 0.392, 95%CI 0.160-0.962, P =0.041) was a protective factor of END. Conclusions The AIS patients with a high NIHSS score before intravenous thrombolysis might be likely to occur END, and the patients with hypertension might be relatively less likely to occur END.

Key words: Ischemic stroke; Intravenous thrombolysis; Early neurological deterioration; Risk factor; Hypertension

曹双双, 张晓燕, 王建伟, 赵磊, 陈红兵, 汪明玉. 急性缺血性卒中静脉溶栓后早期神经功能恶化影响因素分析[J]. 中国卒中杂志, 2021, 16(12): 1253-1258.

CAO Shuangshuang, ZHANG Xiaoyan, WANG Jianwei, ZHAO Lei, CHEN Hongbing, WANG Mingyu. The Related Factors of Early Neurological Deterioration after Intravenous Thrombolysis in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2021, 16(12): 1253-1258.

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