脑小血管病对脑卒中静脉溶栓预后的影响

Effect of Cerebral Small Vessel Disease on the Prognosis of Patients with Ischemic Stroke Treated with Intravenous Thrombolysis

目的探讨脑小血管病(CSVD)对缺血性脑卒中静脉溶栓90 d内神经功能恢复及1 a内脑卒中复发的影响。方法前瞻性纳入2018年11月至2020年5月于郑州大学附属洛阳中心医院就诊的接受静脉溶栓治疗的211例急性缺血性脑卒中患者。根据脑卒中后90 d的改良Rankin量表(mRS)评分将患者分为预后良好组(156例)和预后不良组(55例),根据脑卒中1 a内有无复发将患者分为未复发组(179例)和复发组(32例)。应用单因素分析、logistic回归分析和Cox比例风险回归分析影响脑卒中后神经功能恢复和复发的因素。结果logistic回归分析显示,CSVD评分、基线国立卫生研究院卒中量表(NIHSS)评分、基线mRS评分是脑卒中后90 d预后不良的独立危险因素(P<0.05)。CSVD评分的危险强度(OR=2.795)高于基线NIHSS评分(OR=1.257)及基线mRS评分(OR=1.932)。多因素logistic回归分析和Cox比例风险回归分析显示,CSVD评分和未规律口服阿司匹林是脑卒中后1 a内复发的独立危险因素(P<0.05)。结论CSVD可影响脑卒中静脉溶栓治疗后90 d的神经功能恢复及1 a内缺血性脑卒中的复发。

Objective To explore the effect of cerebral small vessel disease(CSVD)on the neurological function recovery at 90 days after intravenous thrombolysis for ischemic stroke and the recurrence of stroke in 1 year.Methods From November 2018 to May 2020,211 patients with acute ischemic stroke who received intravenous thrombolytic therapy in Luoyang Central Hospital Affiliated to Zhengzhou University were prospectively included.According to the modified Rankin scale(mRS)score at 90 days after stroke,the patients were divided into good prognosis group(156 cases)and poor prognosis group(55 cases),and the patients were divided into non-recurrence group(179 cases)and recurrence group(32 cases)according to whether or not the stroke recurred within 1 year.Univariate analysis,logistic regression analysis and Cox proportional hazards regression analysis were used to analyze the factors affecting the recovery of neurological function after stroke and the recurrence of stroke.Results Logistic regression analysis showed that the scores of CSVD,baseline National Institute of Health stroke scale(NIHSS)and baseline mRS were independent risk factors for poor prognosis 90 days after stroke(P<0.05).The risk intensity of CSVD score(OR=2.795)was higher than that of baseline NIHSS score(OR=1.257)and baseline mRS score(OR=1.932).Multivariate logistic regression analysis and Cox proportional hazards regression analysis showed that CSVD score and irregular oral aspirin were independent risk factors for recurrence within 1 year after stroke(P<0.05).Conclusion CSVD can affect the neurological function recovery at 90 days after ischemic stroke treated with intravenous thrombolysis and stroke recurrence within 1 year.