脑小血管病总负荷与急性缺血性卒中静脉溶栓后早期神经功能恶化的相关性

赵俊杰 司君增

[关键词] 脑小血管病总负荷;急性缺血性卒中;静脉溶栓;早期神经功能恶化

[中图分类号] R749.12          [文献标识码] B          [文章编号] 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）是因腦动脉急性闭塞后引起的局限或全面性神经功能缺损综合征，目前重组组织型纤溶酶原激活剂（Recombinant human tissue-type plasiminogen，rt-PA）静脉溶栓是急性缺血性卒中超早期治疗有效的方法之一。虽然大部分患者可以在此治疗后获益，但仍有少数患者会在溶栓早期出现神经功能恶化、出血转化的情况。应用美国国立卫生研究院卒中量表（National institute of health stroke scale，NIHSS）评估神经功能缺损程度并定义24 h内溶栓前后NIHSS评分增加≥4分者为早期神经功能恶化（Early neurological deterioration，END）[1]。出血性转化（Hemorrhagic transformation，HT）是指 AIS后缺血区的脑血管恢复血流灌注而引起的继发性出血，即在CT/MRI中出现新发的颅内出血[2]。根据其对神经功能缺损的影响程度将其分为症状性颅内出血（Symptomatic intracranial hemorrhage，sICH）和无症状性颅内出血（Asymptomatic intracranial hemorrhage），而欧洲急性卒中协作研究Ⅱ（the european cooperative acute stroke study，ECASS Ⅱ）将 sICH 定义为CT上有出血表现且前后NIHSS 评分增加≥4分或出现临床恶化事件（包括嗜睡或偏瘫加重），sICH 与不良预后相关[3]。