阿替普酶联合丁苯酞对急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化影响的研究

The effect of alteplase combined with butylphthalide on early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke

目的探讨阿替普酶联合丁苯酞对急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的影响。方法对2017年8月至2020年1月在湖北省第三人民医院行静脉溶栓的171例急性缺血性脑卒中患者进行回顾性分析,其中治疗组(给予阿替普酶联合丁苯酞治疗)29例,对照组(给予阿替普酶治疗)142例,运用倾向得分匹配分析平衡2组患者各项临床基线资料并比较2组患者72 h内早期神经功能恶化[美国国立卫生研究院卒中量表(NIHSS)评分较前加重≥4分]发生率的差异。结果2组患者的年龄、性别、NIHSS评分、高血压病史、糖尿病病史、心房颤动病史、冠心病病史、高脂血症病史、脑梗死病史、病前改良Rankin量表评分、收缩压、舒张压、发病至静脉溶栓时间、TOAST分型、抗血小板聚集或抗凝药物史、他汀药物史差异无统计学意义(P>0.05),治疗组患者的血糖、入院至静脉溶栓时间和72 h内早期神经功能恶化发生率低于对照组[(8.54±4.03)mmol/L vs(7.32±2.03)mmol/L;36(25,45)min vs 27(18,43)min;31.0%vs 10.3%],差异具有统计学意义(t=2.407,P=0.018;Z=-2.189,P=0.029;χ^2=5.148,P=0.023)。通过倾向得分匹配成功匹配46例,2组各23例,治疗组患者早期神经功能恶化发生率仍低于对照组(34.8%vs 8.7%),差异具有统计学意义(χ^2=4.60,P=0.032)。结论阿替普酶联合丁苯酞治疗组患者静脉溶栓后早期神经功能恶化发生率低于对照组。

Objective To evaluate the effect of alteplase combined with butylphthalide on early neurological deterioration after intravenous thrombolysis in acute ischemic stroke.Methods A retrospective analysis was performed on 171 patients with acute ischemic stroke undergoing intravenous thrombolysis at the Third People’s Hospital of Hubei Province from August 2017 to January 2020,including 29 patients in the treatment group(alteplase plus butylphthalide)and 142 patients in the control group(alteplase only).Propensity score matching was used to analyze and balance the clinical baseline data of patients in the two groups.The incidence of early neurological deterioration(NIHSS score≥4 points higher than before)within 72 h in the 2 groups was compared.Results There was no statistical difference in age,gender,NIHSS score,hypertension,diabetes,atrial fibrillation,coronary heart disease,hyperlipidemia,cerebral infarction,modified Rankin scale score,systolic pressure,diastolic blood pressure,onset to intravenous thrombolysis time,TOAST classification,antiplatelet or anticoagulant drugs,and statins drugs between the two groups(P>0.05).Blood glucose[(8.54±4.03)mmol/L vs(7.32±2.03)mmol/L,t=2.407,P=0.018)],door to intravenous thrombolysis time[36(25,45)min vs 27(18,43)min,Z=-2.189,P=0.029)]and the incidence of early neurological deterioration within 72 hours(31.0%vs 10.3%,χ^2=5.148,P=0.023)in the treatment group were lower than those in the control group.Twenty-three pairs were matched successfully by the propensity score matching,that is,23 patients in the treatment group and 23 in the control group.The incidence of early neurological deterioration in the treatment group was still lower than that in the control group(8.7%vs 34.8%,χ^2=4.60,P=0.032).Conclusion The incidence of early neurological deterioration after intravenous thrombolysis of alteplase plus butylphthalide group was lower than that of the alteplase group.