【摘要】 目的 探讨阿替普酶静脉溶栓后发生早期神经功能恶化的相关危险因素。方法 选取2018年1月至2021年12月在MRI指导下快速阿替普酶静脉溶栓治疗的419例急性缺血性脑卒中(AIS)患者，依据溶栓治疗24 h内是否出现神经功能恶化分成早期进展性脑卒中组(33例)和早期非进展性脑卒中组(386例)。回顾性分析两组患者的基线资料和检查结果。结果 419例患者中，发生早期神经功能恶化33例(7.88%)；两组间既往高血压病、糖尿病、冠心病、心房颤动、脑卒中病史及吸烟史、饮酒史比较，差异均无统计学意义(均P>0.05)；溶栓前血压、随机血糖和糖化血红蛋白、血脂、同型半胱氨酸、超氧化物歧化酶两组之间比较，差异均无统计学意义(均P>0.05)；患者的空腹血糖、胱抑素水平以及MRI表现为分水岭梗死、腔隙性梗死两组间比较，差异均有统计学意义(均P<0.05)；合并责任大血管重度狭窄或闭塞的患者的两组间比较，差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示，空腹血糖、分水岭梗死是阿替普酶静脉溶栓治疗后发生早期神经功能恶化的危险因素(P<0.05)。结论 空腹血糖水平及MRI提示为分水岭梗死是AIS患者阿替普酶静脉溶栓治疗后出现早期神经功能恶化的独立危险因素。更多还原

【Abstract】 Aim To investigate the risk factors for early neurological deterioration in the patients with acute ischemic stroke after intravenous thrombolytic therapy with alteplase. Methods The patients who received intravenous thrombolytic therapy with alteplase during January 2018 and December 2021 were retrospectively analyzed. They were divided by patient’s conditions into a early progressive stroke group and a non-progressive stroke group. The general data and test results of the two groups were collected for retrospective analysis and comparison. Results A total of 419 acute ischemic stroke patients were enrolled, and 33 patients of them(7.88%) had early neurological deterioration. There were no significant difference in the history of hypertension, diabetes, coronary heart disease, atrial fibrillation, stroke, smoking and drinking. There were no statistically significant differences of blood pressure, random blood glucose, glycosylated hemoglobin, blood lipid, homocysteine and superoxide dismutase. The differences were statistically significant between fasting blood glucose, cystatin, patients with lacunar infarction, and patients with cerebral watershed infarction(P<0.05). There was no statistical difference between the two groups in the presence of severe stenosis or occlusion of the responsible vessels. Logistic analysis results showed that fasting blood glucose and cerebral watershed infarction on cranial MR were significantly associated with early neurological deterioration after thrombolysis(P<0.05). Conclusion Fasting blood glucose and the patients with cerebral watershed infarction on cranial MR was significantly associated with early neurological deterioration after thrombolysis.更多还原