腦小血管病總負荷與急性缺血性卒中靜脈溶栓后早期神經功能惡化的相關性

趙俊杰 司君增

[關鍵詞] 腦小血管病總負荷;急性缺血性卒中;靜脈溶栓;早期神經功能惡化

[中圖分類號] R749.12? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）21-0042-03

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

ZHAO Junjie? ?SI Junzeng

Department of Neurology，the People′s Hospital of Ji′nan City，Ji′nan? ?271199，China

[Abstract] 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）， χ2=6.774， P=0.009]， HT [11.58% （11/95） vs. 40.00% （24/60）， χ2=12.430， P=0.001] and SICH [7.37% （7/95） vs. 20.00% （12/60）， χ2=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.

[Key words] Total load of cerebral small vessel disease; Acute ischemic stroke; Intravenous thrombolysis; Early deterioration of neurological function

急性缺血性卒中（Acute ischemic stroke，AIS）是因腦動脈急性閉塞后引起的局限或全面性神經功能缺損綜合征，目前重組組織型纖溶酶原激活劑（Recombinant human tissue-type plasiminogen，rt-PA）靜脈溶栓是急性缺血性卒中超早期治療有效的方法之一。雖然大部分患者可以在此治療后獲益，但仍有少數患者會在溶栓早期出現神經功能惡化、出血轉化的情況。應用美國國立衛生研究院卒中量表（National institute of health stroke scale，NIHSS）評估神經功能缺損程度并定義24 h內溶栓前后NIHSS評分增加≥4分者為早期神經功能惡化（Early neurological deterioration，END）[1]。出血性轉化（Hemorrhagic transformation，HT）是指 AIS后缺血區的腦血管恢復血流灌注而引起的繼發性出血，即在CT/MRI中出現新發的顱內出血[2]。根據其對神經功能缺損的影響程度將其分為癥狀性顱內出血（Symptomatic intracranial hemorrhage，sICH）和無癥狀性顱內出血（Asymptomatic intracranial hemorrhage），而歐洲急性卒中協作研究Ⅱ（the european cooperative acute stroke study，ECASS Ⅱ）將 sICH 定義為CT上有出血表現且前后NIHSS 評分增加≥4分或出現臨床惡化事件（包括嗜睡或偏癱加重），sICH 與不良預后相關[3]。