脑小血管病总体负担对缺血性脑卒中rt-PA溶栓预后的影响

Effect of the overall burden of cerebral small vessel disease on the prognosis of rt-PA thrombolysis in ischemic stroke

目的:探究脑小血管病(CSVD)总体负担对缺血性脑卒中重组组织型纤溶酶原激活剂(rt-PA)溶栓预后的影响。方法:选择100例缺血性脑卒中病人作为研究对象,均进行rt-PA溶栓治疗,根据病人发病后3个月的日常生活活动能力(ADL)评分,以60分为界值,将总分>60分者分为预后良好组,≤60分者分为预后不良组。比较2组的基本资料、美国国立卫生研究院卒中量表(NIHSS)评分、CSVD总体负担评分,并用多因素logistic回归分析CSVD总体负担对缺血性脑卒中rt-PA溶栓预后的影响。结果:2组病人的性别、酗酒史、吸烟史、高血压、冠心病、梗死位置比较差异均无统计学意义(P>0.05);预后良好组年龄>60岁的比例低于不良组(P<0.01),梗死灶面积、NIHSS总分、CSVD总体负担总分均低于预后不良组(P<0.01)。多因素logistic回归分析显示,年龄>60岁、梗死灶面积>3.0 cm^(2)、NIHSS>15分、CSVD总体负担>2分均是缺血性脑卒中rt-PA溶栓预后不良的独立危险因素(P<0.05~P<0.01)。结论:年龄、梗死灶面积、NIHSS、CSVD总体负担越大,缺血性脑卒中rt-PA溶栓预后越差,临床可据此调整诊疗方案。

Objective:To expore the effects of the overall burden of cerebral small vessel disease(CSVD)on the prognosis of recombinant tissue plasminogen activator(rt-PA)thrombolysis in ischemic stroke.Methods:A total of 100 patients with ischemic stroke were selected as the research object,and treated with rt-PA thrombolysis.According to the daily living activity(ADL)score of 3 months after the onset of disease,the patients with total score>60 points and≤60 points were divided into the good prognosis group and poor prognosis group,respectively.The basic data,National Institutes of Health stroke scale(NIHSS)and total burden score of CSVD were compared between two groups,and the multivariate logistic regression analysis was used to analyze the effects of the overall burden of CSDV on the prognosis of rt-PA thrombolysis in ischemic stroke.Results:There was no statistical significance in the gender,alcohol history,smoking history,hypertension,coronary heart disease and infarct location between two groups(P>0.05).The proportion of patients with age>60 years old in good prognosis group was lower than that in poor prognosis group(P<0.01),and the infarct area,total NIHSS score and total burden score of CSVD in good prognosis group were lower than those in poor prognosis group(P<0.01).The results of multivariate logistic regression analysis showed that the age>60 years old,infarct area>3.0 cm^(2),NIHSS>15 points,overall burden of CSVD>2 points were the independent risk factors of poor prognosis of rt-PA thrombolysis in ischemic stroke(P<0.05 to P<0.01).Conclusions:The greater the age,infarct size,NIHSS,and overall burden of CSVD are,the worse the prognosis of ischemic stroke rt-PA thrombolysis is,and the clinical diagnosis and treatment plan can be adjusted accordingly.