穿支动脉粥样硬化病静脉溶栓后发生早期神经功能恶化的危险因素分析

Analysis of risk factors for early neurological deterioration in patients with perforating artery atherosclerosis treated by intravenous thrombolysis with ateplase

目的探讨穿支动脉粥样硬化病(BAD)行阿替普酶静脉溶栓后发生早期神经功能恶化(END)的危险因素。方法回顾性选取2021年1月至2023年1月于咸阳市中心医院神经内科住院并接受阿替普酶静脉溶栓治疗的急性脑梗死患者639例。静脉溶栓后行颅脑磁共振弥散加权成像+磁共振血管造影,证实为新发脑梗死,根据中国缺血性脑卒中分型标准筛选符合BAD的患者162例,年龄(63.71±11.44)岁,男112例(69.1%)、女50例(30.9%)。根据静脉溶栓治疗72 h内是否出现END分为END组(28例)及非进展组(134例)。组间比较采用独立样本t检验、χ^(2)检验或Fisher确切概率法、Mann-Whitney U检验,采用单因素和二元logistic回归分析阿替普酶静脉溶栓治疗BAD发生END的危险因素。结果单因素结果显示,END组患者溶栓前的美国国立卫生院卒中量表(NIHSS)评分、中重度卒中(NIHSS评分5~21分)、入院时收缩压、到院-溶栓时间(DNT)及中重度白质疏松程度均高于非进展组(均P<0.05)。进一步二元logistic回归分析显示,溶栓前NIHSS评分(OR=5.947,95%CI 2.822~46.775,P=0.020)、中重度白质疏松程度(OR=3.162,95%CI 1.272~22.357,P=0.034)是阿替普酶静脉溶栓后BAD患者发生END的独立危险因素。结论溶栓前NIHSS评分、中重度白质疏松程度为BAD行阿替普酶静脉溶栓后发生END的独立危险因素。

Objective To explore the risk factors of early neurological deterioration in patients with perforating artery atherosclerosis treated by intravenous thrombolysis with alteplase.Methods A retrospective study was conducted on 639 patients with acute cerebral infarction who were hospitalized in Department of Neurology,Xianyang Central Hospital from January 2021 to January 2023 and received intravenous thrombolysis with ateplase.After intravenous thrombolysis,magnetic resonance diffusion-weighted imaging and angiography were completed,confirming the diagnosis of newly diagnosed cerebral infarction.According to the Chinese ischemic stroke subclassification(CISS)classification criteria,162 patients who met BAD were selected,including 112 males(69.1%)and 50 females(30.9%);they were(63.71±11.44)years old.According to whether the patient experienced early neurological deterioration(END)within 72 hours of intravenous thrombolysis with ateplase,they were divided into an END group(28 cases)and a non-progression group(134 cases).The data were compared between the two groups by independent-sample t test,χ^(2) test,or Fisher's precision probability test,and Mann-Whitney U test.Single factor analysis and multivariate logistic regression analysis were used to identify the risk factors of early neurological deterioration in the patients with perforating artery atherosclerosis treated by intravenous thrombolysis with ateplase.Results The univariate analysis showed that the score of National Institute of Health Stroke Scale(NIHSS)before thrombolysis,moderate to severe stroke(NIHSS score 5-21),systolic blood pressure at admission,door-to-needle time(DNT),and moderate to severe white matter osteoporosis in the END group were higher than those in the non-progression group(all P<0.05).Further multivariate logistic regression analysis showed that the score of NIHSS before thrombolysis(OR=5.947,95%CI 2.822-46.775,P=0.020)and moderate to severe white matter osteoporosis(OR=3.162,95%CI 1.272-22.357,P=0.034)were risk factors for BAD in the patients.Conclusion NIHSS score before thrombolysis and degree of moderate to severe white matter osteoporosis are risk factors for END in patients with perforating artery atherosclerosis treated by intravenous thrombolysis with alteplase.