脑小血管病总负荷与急性缺血性卒中静脉溶栓后早期神经功能恶化的相关性

Correlation between total load of cerebral small vessel disease and early deterioration of neurological function of patients with acute ischemic stroke after intravenous thrombolysis

目的研究脑小血管病总负荷与急性缺血性卒中静脉溶栓后早期神经功能恶化的相关性。方法回顾性纳入2019年5月至2020年10月就诊于济南市人民医院卒中中心(发病4.5 h内)接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的急性缺血性卒中患者。记录患者一般资料、临床特征并在48 h内完善头MR后评估CSVD总负荷。根据CSVD总负荷得分将患者分为轻中度组(CSVD 0~2分)和重度组(CSVD 3~4分)两组。最后比较两组的一般资料和临床特征。结果155例受试者中轻中度组(CSVD 0~2分)95例,重度组(CSVD 3~4分)60例,其中两组间年龄、性别、血管危险因素比较,差异无统计学意义(P>0.05)。重度组与轻中度组临床资料比较后显示,END[9.47%(9/95)vs.25.00%(15/60),χ^(2)=6.774,P=0.009]、HT[11.58%(11/95)vs.40.00%(24/60),χ^(2)=12.430,P=0.001]、sICH[7.37%(7/95)vs.20.00%(12/60),χ^(2)=5.460,P=0.020],差异有统计学意义(P<0.05)。结论急性缺血性卒中患者CSVD总体负荷严重程度与溶栓后早期神经功能恶化、出血转化、症状性颅内出血呈正相关。

Objective To study the correlation between the total load of cerebral small vessel disease(CSVD)and the early deterioration of neurological function of patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods AIS patients who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)(within 4.5 hours after onset)in the Stroke Center of People′s Hospital of Jinan City from May 2019 to October 2020 were retrospectively included.The general data and clinical features of patients were recorded,and the total load of CSVD was evaluated within 48 hours after cerebral MR.According to CSVD total load score,patients were divided into the mild and moderate group(CSVD:0-2 points)and the severe group(CSVD:3-4 points).Finally,the general data and clinical features of the two groups were compared to determine whether there are statistically significant differences between two groups.Results Among 155 objects,there were 95 cases in the mild and moderate group(CSVD:0-2 points)and 60 cases in the severe group(CSVD:3-4 points).There were no statistically significant differences in age,gender,and vascular risk factors between the two groups.The clinical data of the severe group and the mild and moderate group showed that,there were statistically significant differences in END[9.47%(9/95)vs.25.00%(15/60),χ^(2)=6.774,P=0.009],HT[11.58%(11/95)vs.40.00%(24/60),χ^(2)=12.430,P=0.001]and SICH[7.37%(7/95)vs.20.00%(12/60),χ^(2)=5.460,P=0.020](P<0.05).Conclusion There is a positive correlation between the severity of the total load of CSVD and the early deterioration of neurological function,hemorrhage transformation and symptomatic intracranial hemorrhage of AIS patients after thrombolysis.