轻中度急性缺血性脑卒中静脉溶栓序贯丁苯酞治疗与早期神经功能恶化影响的相关性
Association between Intravenous Thrombolysis and Early Neurological Deterioration Effects of Sequential Butylphthalide Treatment in Mild to Moderate Acute Ischemic Stroke

目的：探讨静脉溶栓序贯丁苯酞治疗轻中度急性缺血性脑卒(acute ischemic stroke, AIS)中后早期神经功能恶化(early neurological function deterioration, END)影响的相关性。方法：连续纳入2019年1月至2021年12月期间在云南省滇南中心医院卒中单元进行静脉溶栓的轻中度急性缺血性卒中(acute ischemic stroke, AIS)患者。收集患者临床、影像学和实验室检查资料。早期神经功能恶化(neurological function deterioration, END)定义为急性缺血性脑卒中r-tPA静脉溶栓后7天内，美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分最高分较入院时增加≥2分，或运动功能评分 ≥ 1分。应用多变量logistic回归分析确定静脉溶栓序贯丁苯酞治疗与END的是否发生独立相关性。结果：共纳入146例AIS患者，共有14例(9.59%)患者发生END。END组与非END组在高脂血症史、心房颤动史、收缩压、舒张压及OSCP分型方面差异有统计学意义(P均<0.05)。两组患者在人口统计学、其余血管危险因素、实验室检查结果、ONT、基线NIHSS评分、FAZEKAS分级及是否使用丁苯酞等临床资料方面均无统计学差异。单因素分析筛选出轻中度AIS静脉溶栓后END与收缩压、舒张压、高脂血症史及OSCP分型有关，差异有统计学意义。分层分析丁苯酞使用与否与END无相关性。最后通过多因素Logistic回归分析，调整收缩压、舒张压、高脂血症史及OSCP分型后，是否使用丁苯酞与是否发生END在总体人群、女性及男性方面均无相关性。结论：是否使用丁苯酞与轻中度AIS患者静脉溶栓后7天发生END无相关性，丁苯酞不能改善7天内轻中度AIS r-tPA静脉溶栓患者的预后。
Objective: To investigate the association between early neurological function degeneration (END) after intravenous thrombolysis sequentially Butylphthalide administration in mild to moderate acute ischemic stroke (AIS). Method: Patients with mild to moderate AIS who underwent intrave-nous thrombolysis at the stroke unit of Yunnan Center Hospital between January 2019 and Decem-ber 2021 were consecutively enrolled. Data on patients’ clinical, radiographic, and laboratory ex-aminations were collected. Early neurological deterioration (end) was defined as an increase of ≥ 2 points in the maximum National Institutes of Health Stroke Scale (NIHSS) score, or ≥ 1 point in the motor function score within 7 days after intravenous thrombolysis with r-tPA for acute ischemic stroke. Multivariable logistic regression analysis was applied to determine whether the independ-ent association of intravenous thrombolysis sequential Butylphthalide treatment and end occurred. Results: A total of 146 AIS patients were included, and a total of 14 (9.59%) patients developed END. There were significant differences between END and non END groups in hyperlipidemia history, atrial fibrillation history, systolic blood pressure, diastolic blood pressure and oscp classification (all P < 0.05). There were no statistically significant differences between the two groups in terms of de-mographics, remaining vascular risk factors, laboratory findings, ont, baseline NIHSS score, Fazekas grade, and clinical data regarding the use or not of Butylphthalide. In univariate analysis, END was related to systolic blood pressure, diastolic blood pressure, history of hyperlipidemia and oscp clas-sification in mild to moderate AIS after intravenous thrombolysis with statistical