静脉溶栓时间与急性轻型脑梗死及短暂性脑缺血发作患者早期认知功能的关系

Relationship between time of intravenous thrombolysis and early cognitive function in patients with acute mild ischemic stroke and transient ischemic attack

目的探讨静脉溶栓时间对急性轻型脑梗死和短暂性脑缺血发作患者早期认知功能的影响。方法收集2017年1月—2019年12月就诊于温州医科大学附属第一医院急性轻型脑梗死和短暂性脑缺血发作的173例患者(美国国立卫生研究院卒中量表,NIHSS≤6分),这些患者在发病4.5 h内接受静脉溶栓治疗。最终有156例纳入研究,根据患者发病30 d是否存在认知功能障碍,将其分为认知障碍组(100例)和非认知障碍组(56例),总结2组的基线特征、静脉溶栓时间和认知障碍的发生情况,分析静脉溶栓时间对早期认知障碍发生的影响。结果认知障碍组年龄明显高于非认知障碍组(P=0.037);受教育时间明显短于非认知障碍组(P=0.011);高血压、糖尿病病程、静脉溶栓时间明显长于非认知障碍组(P=0.036、0.003、0.017);总胆固醇明显高于非认知障碍组(P=0.040)。Logistic回归分析显示,年龄大(OR=1.092,95%CI:1.031~1.157,P=0.002)、高血压病程长(OR=1.238,95%CI:1.002~1.193,P=0.021)、糖尿病病程长(OR=1.265,95%CI:1.116~1.384,P=0.016)、静脉溶栓时间长(OR=1.105,95%CI:1.067~1.356,P=0.010)是静脉溶栓后30 d认知功能损害的独立危险因素。结论缩短静脉溶栓时间可能会减少急性轻型脑梗死和短暂性脑缺血发作患者早期认知障碍的发生。

Objective To investigate the influence of intravenous thrombolytic time on early cognitive function in patients with acute mild ischemic stroke(MIS),and transient ischemic attack(TIA).Methods A total of 173 MIS and TIA patients(The National Institutes of Health Stroke,NIHSS≤6)who were admitted to the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2019 were collected.These patients received intravenous thrombolytic therapy within 4.5 hours of onset.A total of 156 cases were finally included in the study.According to whether the patients had cognitive dysfunction 30 days after the onset of the disease,they were divided into cognitive impairment group(n=100)and non-cognitive impairment group(n=56).The baseline characteristics,intravenous thrombolytic time and the occurrence of cognitive impairment of the two groups were summarized,and the impact of intravenous thrombolytic time on the occurrence of early cognitive impairment was analyzed.Results The age of cognitive impairment group was significantly higher than that of non-cognitive impairment group(P=0.037);the educational time was significantly shorter than that of non-cognitive impairment group(P=0.011);the course of hypertension and diabetes,intravenous thrombolysis time was significantly longer than the non-cognitive impairment group(P=0.036,0.003,0.017);the cognitive impairment group had significantly higher total cholesterol than the non-cognitive impairment group(P=0.040).Logistic regression showed that older age(OR=1.092,95%CI:1.031-1.157,P=0.002),longer duration of hypertension(OR=1.238,95%CI:1.002-1.193,P=0.021),longer duration of diabetes(OR=1.265,95%CI:1.116-1.384,P=0.016),and longer duration of intravenous thrombolysis(OR=1.105,95%CI:1.067-1.356,P=0.010)were associated with cognitive impairment 30 days after intravenous thrombolysis independent risk factors.Conclusion Shortening the time of intravenous thrombolysis after onset may help reduce patient'early cognitive impairment in patients with acute mild ischemic stroke,and transient ischemic attack.