阿替普酶溶栓治疗急性脑梗死早期神经功能恶化的相关危险因素分析

目的 分析阿替普酶溶栓治疗急性脑梗死早期神经功能恶化的相关危险因素。方法 选择2013年1月-2018年6月本院神经内科收治的发病4.5 h内给予阿替普酶溶栓治疗的急性脑梗死患者114例,根据阿替普酶治疗后是否发生早期神经功能恶化(Early neurologic deterioration,END)分为恶化组(43例)和非恶化组(71例),收集2组临床基线资料,分析阿替普酶溶栓治疗患者发生END的危险因素。结果 恶化组饮酒人数、吞咽功能障碍人数、责任大血管闭塞数、心源性脑栓塞数、白细胞计数、TC、LDL-C、脂蛋白(a)、ApoB、肌酐水平等指标均显著高于非恶化组(P均<0.05),而HDL-C水平明显低于非恶化组(P<0.05),而其它基线资料比较无明显差异(P均>0.05); Logistic回归分析显示脂蛋白(a)、HDL-C水平、责任大血管闭塞、心源性脑栓塞均与患者溶栓后发生END显著相关(P<0.05)。结论 脂蛋白(a)及HDL-C水平异常、责任大血管闭塞、心源性脑栓塞等均为溶栓治疗急性脑梗死END的独立危险因素。

The analysis of the risk factor for early neurologic deterioration in using Alteplase Thrombolysis to treat acute cerebral infarction

ObjectiveTo analyze the risk factor for early neurologic deterioration in using Alteplase thrombolysis to treat acute cerebral infarction.Methods 114 patients with acute cerebral infarction were selected,they were treated alteplase thrombolytic therapy within 4.5 h of the onset at the department of neurology in our hospital from January 2013 to June 2018,and they were divided into the deterioration group(43 cases)and the non-deterioration group(71 cases)according to whether Early neurologic deterioration occurred after alteplase treatment.The clinical baseline data of the two groups were collected and compared,and the risk factors of END in patients treated with alteplase thrombolysis were analyzed.Results The number of alcohol consumption,swallowing dysfunction,major vessel occlusion,and cardiogenic cerebral embolism,and white blood cell count,TC value,ldl-c value,lipoprotein(a)value,ApoB,creatinine value in the deteriorating group were significantly higher than those in the non-deteriorating group(all P<0.05),however HDL-C level was significantly lower than that in the non-deteriorating group(P<0.05),and there were no statistically significant differences in other baseline data(all P>0.05); Logistic regression analysis showed that lipoprotein(a)level,hdl-c level,responsible large vessel occlusion,and cardiogenic cerebral embolism were all significantly correlated with the END after thrombolysis(P<0.05).Conclusion Lipoprotein(a)and HDL-C abnormalities,responsible large vessels occlusion,and cardiogenic cerebral embolism were all independent risk factors for END in Acute cerebral infarction after alteplase treatment.