肢体缺血预处理在非心源性缺血性脑卒中患者二级预防中临床应用研究

Clinical application of limbs ischemic precondition in non-cardiac ischemic stroke patients for secondary prevention

目的探讨肢体缺血预处理(LIPre C)在非心源性缺血性脑卒中患者二级预防中临床应用疗效。方法选择2011年6月—2014年5月在温州医科大学附属第六医院神经内科接受诊治,经临床和影像证实为非心源性缺血性脑卒中的患者360例,按照随机数字表法分为LIPre C组和对照组(CON组)各180例。入组前后2组均严格按照2010年中国缺血性卒中和短暂性脑缺血发作(TIA)二级预防指南用药,控制危险因素。LIPre C组患者入组后接受LIPre C训练,治疗期为1年。使用3.0 T磁共振分析患者颅内缺血病灶,应用美国国立卫生研究院卒中量表(NIHSS)、简易精神状态评价量表(MMSE)评分标准评价患者临床症状、恢复程度及认知功能。分析统计治疗期脑梗死的复发率及神经功能改善的情况。结果 1 LIPre C组脑梗死复发率(4.4%,8例)低于CON组(10.6%,19例),P=0.044。2LIPer C组腔隙性脑梗死灶增加的发生率(13.3%,24例)低于CON组(23.9%,43例),P=0.014。3MRI分析显示LIPre C组复发脑梗死体积[(3.6±1.7)ml]小于CON组[(5.4±1.3)ml],P=0.004。4LIPre C组人均腔梗病灶增加计数(1.6±0.2)小于CON组(1.7±0.1),P=0.015。5LIPre C组神经缺失症状改善率(90.6%,163例)高于CON组(82.8%,149例),P=0.043。6LIPre C组认知功能改善率(88.6%,31例)亦明显高于CON组(64.9%,24例),P=0.026。结论 LIPre C能够降低非心源性缺血性脑卒中复发率,减小复发脑梗死体积,减少新增腔隙性脑梗死灶数量,降低二次卒中严重程度,有效改善卒中患者肢体及认知功能,在非心源性缺血性脑卒中二级预防中具有广阔的应用前景。

Objective To investigate the clinical efficacy of limb ischemic preconditioning（LIPreC） in non-cardiac ischemic stroke patients for secondary prevention. Methods A total of 360 patients with non-cardiac ischemic stroke confirmed by clinic and imaging from June,2011 to May,2014 were recruited and randomized divided by 1： 1 into LIPreC group and control group（ CON group）. Accordance with the medication of China ischemic stroke and TIA secondary prevention guidelines 2010, both groups were treated to control the risk factors before or after recruitment. LIPreC group was given limb ischemic precondition training after the recruitment for one year. The ischemic lesions in head were analyzed by 3.0 T MR. NIHSS and MMSE were used to evaluate the clinical symptoms, recovery degree and cognitive function. The neurological improvement and re-infarction rate of patients were observed. Results （1）The recurrence rate of cerebral infarction in LIPreC group（4.4%, 8 cases） was lower than that in CON group（ 10.6%, 19 cases） ,P = 0. 044. （2）The incidence of increasing intracranial lacunar infarct in LIPerC group（ 13.3% ,24 cases） was lower than that in CON group （23.9% ,43 cases） ,P =0. 014. （3）MRI examination showed that the recurrent infarct volume in LIPreC group[ （3.6 ±1.7 ） ml ] was smaller than that in CON group [ （5.4 ± 1.3 ） ml ], P = 0.004. （4）The increased lacunar lesions count per capita in LIPreC group（ 1.6 ±0.2） was less than CON group（ 1.7 ±0.1 ） ,P =0. 015. （5）The improvement rate of neurological deficit symptoms in LIPreC group（90.6% ,163 cases） was higher than that in CON group（82.8% ,149 cases）, P = 0.043. （6）The improvement rate of cognition in LIPreC group （88.6%, 31 cases） was significantly higher than that in CON group（64.9%, 24 cases ）, P = 0. 026. Conclusion LIPreC can reduce the recurrence rate of acute ischemic stroke,infarct volume of recurrence, number of new lacunar infarct and severity of secondary stroke, and so physical and cognitive dysfunction of non-cardiac ischemic stroke patients. LIPreC has a wide application prospect in the area of noncardiac ischemic stroke secondary prevention.