银杏二萜内酯葡胺对轻型缺血性卒中患者早期神经功能恶化的影响

Effect of ginkgo diterpene lactone meglumine on early neurological deterioration in patients with minor ischemic stroke

目的探讨银杏二萜内酯葡胺联合双重抗血小板治疗对轻型缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的影响。方法利用苏州市立医院北区卒中中心数据库,回顾性连续纳入2019年1月至2020年6月期间在发病48 h内接受双抗治疗的轻型缺血性卒中患者的临床资料。根据是否联合使用银杏二萜内酯葡胺分为联合治疗组与双抗治疗组。END定义为发病7 d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分或运动项目评分增加≥1分。采用多变量logistic回归分析确定END的独立影响因素。结果共纳入155例患者,联合治疗组84例,双抗治疗组71例。发病7 d内共有21例(13.5%)患者发生END,其中联合治疗组6例,双抗治疗组15例。两组治疗期间均无出血病例。单变量分析显示,低密度脂蛋白胆固醇、空腹血糖、卒中分布、是否联合使用银杏二萜内酯葡胺等因素可能与END有关(P均<0.1)。多变量logistic回归分析显示,在校正低密度脂蛋白胆固醇、空腹血糖水平、卒中分布等混杂因素后,联合使用银杏二萜内酯葡胺与END呈显著独立负相关(优势比0.233,95%可信区间0.078~0.796;P=0.009)。结论银杏二萜内酯葡胺联合双抗治疗可降低轻型缺血性卒中患者END发生率,且不会增高出血风险。

Objective To investigate the effect of ginkgo diterpene lactone meglumine(GDLM)combined with dual antiplatelet therapy on early neurological deterioration(END)in patients with mild ischemic stroke.Methods Using North District of Suzhou Municipal Hospital Stroke Database,the clinical data of consecutive patients with minor ischemic stroke received dual antiplatelet therapy within 48 h of onset from January 2019 to June 2020 were enrolled retrospectively.According to whether GDLM is used in combination,they are divided into combined treatment group and dual antiplatelet therapy group.END was defined as the National Institutes of Health Stroke Scale(NIHSS)score within 7 d after onset increased≥2 or motor function score≥1 compared with the baseline.Multivariate logistic regression analysis was used to identify the independent influencing factors of END.Results A total of 155 patients were included in the study,including 84 in combined treatment group and 71 in dual antiplatelet therapy group.Within 7 d after onset,21 patients(13.5%)had END,including 6 in the combined treatment group and 15 in the dual antiplatelet therapy group.There was no bleeding in both groups during the treatment.Univariate analysis showed that low-density lipoprotein cholesterol,fasting blood glucose,stroke distribution,and whether combined use of GDLM might be associated with END(all P<0.1).Multivariate logistic regression analysis showed that after adjusting for confounding factors such as low-density lipoprotein cholesterol,fasting blood glucose,and stroke distribution,the combined use of GDLM was significantly negatively correlated with END(odds ratio 0.233,95% confidence interval 0.078-0.796;P=0.009).Conclusion GDLM combined with dual antiplatelet therapy can reduce the incidence of END in patients with mild ischemic stroke;it does not increase the risk of hemorrhage.