阿加曲班与急性轻中度缺血性脑卒中早期神经系统功能改变的相关性研究

目的 探讨阿加曲班对轻中度急性缺血性脑卒中患者的早期神经功能恢复的改善情况；并对不同卒中亚型的疗效进行比较，对阿加曲班疗效的影响因素进行相关性分析。方法 根据纳入及排除标准收集2019年12月1日—2021年6月1日新疆军区总医院收治的急性非心源性轻中度急性缺血性脑卒中患者，按照患者是否使用阿加曲班治疗作为分组的依据，390例入选患者分为阿加曲班组（285例）和未使用阿加曲班的对照组（105例），收集两组患者性别、年龄、高血压、糖尿病、冠心病、既往卒中史、吸烟史等基线资料，收集治疗前后患者低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、总胆固醇（TC）、抗血小板药物使用情况、入院时及治疗7 d时美国国家卫生研究院卒中量表（NIHSS）评分和改良Rankin量表（mRS）评分及卒中病因分型等数据。卒中分型诊断标准按中国缺血性卒中亚型（CISS）分型。以住院第7天时NIHSS评分和mRS评分为疗效指标，进行相关性分析。结果 阿加曲班组与对照组患者年龄，高血压、糖尿病、既往卒中、冠心病患病人数，吸烟史，LDL-C、HDL-C、TC、TG水平，入院时NIHSS评分，服用抗血小板药物种类等基线资料组间比较，差异均无统计学意义（P＞0.05），两组间治疗7 d时NIHSS评分、治疗7 d时NIHSS评分变化、治疗7 d时mRS评分、大动脉粥样硬化型例数、穿支动脉病变型例数差异有统计学差异（P＜0.05），在大动脉粥样硬化型亚组中，两组间年龄、入院时NIHSS评分、治疗7 d时NIHSS评分变化差异有统计学意义（P＜0.05）；在穿支动脉病变型亚组中，两组间入院时NIHSS评分、治疗7 d时NIHSS评分差异有统计学意义（P＜0.05），治疗7 d时NIHSS评分改变与使用阿加曲班呈正相关，差异有统计学意义（P＜0.05）；患有高血压与治疗7 d时NIHSS评分，冠心病史、LDL-C水平与治疗7 d时mRS评分均呈正相关，差异有统计学意义（P＜0.05）；既往卒中病史与治疗7 d时NIHSS评分改变呈负相关，差异有统计学意义（P＜0.05）。结论 阿加曲班可以改善非心源性轻中度急性缺血性脑卒中患者的早期预后，卒中分型、合并高血压、冠心病史、既往卒中病史等因素对阿加曲班疗效有影响。

Correlation between argatroban and early changes of nervous system function in patients with acute mild to moderate ischemic stroke

Objective To investigate the effect of argatroban on the early recovery of neurological function in patients with mild to moderate acute ischemic stroke. The curative effects of different subtypes of stroke were compared, and the influencing factors of the curative effect of argatroban were analyzed. Methods According to the inclusion and exclusion criteria, the patients with acute non cardiogenic mild to moderate acute ischemic stroke treated in the General Hospital of Xinjiang Military Region from December 1, 2019 to June 1, 2021 were collected. According to whether the patients were treated with argatroban or not, 390 patients were divided into argatroban (285 cases) and control group without argatroban (105 cases). Baseline data of two groups of patients were collected from gender, age, hypertension, diabetes, coronary heart disease, past stroke history and smoking history. Low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), three glycerol (TG), cholesterol (TC) and antiplatelet drugs were collected before and after treatment. National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score and stroke etiology classification at admission and seven days after treatment. Stroke was classified according to the Chinese ischemic stroke subtype (CISS). The NIHSS score and mRS score on the 7th day of hospitalization were used as efficacy indicators for correlation analysis. Results There were no statistically significant differences in the age, hypertension, diabetes, past stroke, coronary heart disease, smoking history, LDL-C, HDL-C, TC, TG levels, NIHSS score at admission, and the type of antiplatelet drugs used in two group (P > 0.05). There were significant differences in NIHSS score, change of the NIHSS score after seven days of treatment, mRS score, the number of cases of large atherosclerosis disease and the number of cases of perforating artery disease in two groups (P < 0.05). In the subgroup of large atherosclerosis disease, there were significant differences in age, NIHSS score at admission and NIHSS score at seven days of treatment between two groups (P < 0.05). In the subgroup of perforating artery disease, there was significant difference between the two groups in NIHSS score at admission and NIHSS score at seven days of treatment (P < 0.05). The change of NIHSS score at seven days of treatment was positively correlated with the use of argatroban (P < 0.05). The history of coronary heart disease and the level of LDL-C were positively correlated with the mRS score at seven days of treatment (P < 0.05), and the history of previous stroke was negatively correlated with the change of NIHSS score at seven days of treatment (P < 0.05). Conclusion Argatroban can improve the early prognosis of patients with non cardiogenic mild to moderate acute ischemic stroke. Stroke classification, combined hypertension, history of coronary heart disease, history of previous stroke and other factors have an impact on the efficacy of argatroban.