静脉溶栓时间与急性轻型脑梗死及短暂性脑缺血发作患者早期认知功能的关系

王虹; 王柳清; 张万里; 王贞; 叶祖森; 程一帆; 黄欢捷; 邵蓓

doi:10.16766/j.cnki.issn.1674-4152.002808

静脉溶栓时间与急性轻型脑梗死及短暂性脑缺血发作患者早期认知功能的关系

doi: 10.16766/j.cnki.issn.1674-4152.002808

1.
温州医科大学附属第一医院神经内科, 浙江温州 325000
2.
南京市高淳区人民医院神经内科, 江苏南京 211300
3.
浙江省人民医院神经内科, 浙江杭州 310000

基金项目:

浙江省自然科学基金项目 LY19H090013

浙江省医药卫生科技计划项目 2020KY637

浙江省温州市科技计划项目 2017Y0911

详细信息

通讯作者:
王虹, E-mail: wanghong0710@126.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2022-02-04
- 网络出版日期: 2023-04-07

Relationship between time of intravenous thrombolysis and early cognitive function in patients with acute mild ischemic stroke and transient ischemic attack

1.
Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨静脉溶栓时间对急性轻型脑梗死和短暂性脑缺血发作患者早期认知功能的影响。方法收集2017年1月—2019年12月就诊于温州医科大学附属第一医院急性轻型脑梗死和短暂性脑缺血发作的173例患者(美国国立卫生研究院卒中量表，NIHSS≤6分)，这些患者在发病4.5 h内接受静脉溶栓治疗。最终有156例纳入研究，根据患者发病30 d是否存在认知功能障碍，将其分为认知障碍组(100例)和非认知障碍组(56例)，总结2组的基线特征、静脉溶栓时间和认知障碍的发生情况，分析静脉溶栓时间对早期认知障碍发生的影响。结果认知障碍组年龄明显高于非认知障碍组(P=0.037)；受教育时间明显短于非认知障碍组(P=0.011)；高血压、糖尿病病程、静脉溶栓时间明显长于非认知障碍组(P=0.036、0.003、0.017)；总胆固醇明显高于非认知障碍组(P=0.040)。Logistic回归分析显示，年龄大(OR=1.092，95% CI：1.031~1.157，P=0.002)、高血压病程长(OR=1.238，95% CI：1.002~1.193，P=0.021)、糖尿病病程长(OR=1.265，95% CI：1.116~1.384，P=0.016)、静脉溶栓时间长(OR=1.105，95% CI：1.067~1.356，P=0.010)是静脉溶栓后30 d认知功能损害的独立危险因素。结论缩短静脉溶栓时间可能会减少急性轻型脑梗死和短暂性脑缺血发作患者早期认知障碍的发生。
- 急性轻型脑梗死 /
- 短暂性脑缺血发作 /
- 静脉溶栓 /
- 认知障碍
Abstract: Objective To investigate the influence of intravenous thrombolytic time on early cognitive function in patients with acute mild ischemic stroke (MIS), and transient ischemic attack (TIA). Methods A total of 173 MIS and TIA patients (The National Institutes of Health Stroke, NIHSS ≤6) who were admitted to the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2019 were collected. These patients received intravenous thrombolytic therapy within 4.5 hours of onset. A total of 156 cases were finally included in the study. According to whether the patients had cognitive dysfunction 30 days after the onset of the disease, they were divided into cognitive impairment group (n=100) and non-cognitive impairment group (n=56). The baseline characteristics, intravenous thrombolytic time and the occurrence of cognitive impairment of the two groups were summarized, and the impact of intravenous thrombolytic time on the occurrence of early cognitive impairment was analyzed. Results The age of cognitive impairment group was significantly higher than that of non-cognitive impairment group (P=0.037); the educational time was significantly shorter than that of non-cognitive impairment group (P=0.011); the course of hypertension and diabetes, intravenous thrombolysis time was significantly longer than the non-cognitive impairment group (P=0.036, 0.003, 0.017); the cognitive impairment group had significantly higher total cholesterol than the non-cognitive impairment group (P=0.040). Logistic regression showed that older age (OR=1.092, 95% CI: 1.031-1.157, P=0.002), longer duration of hypertension (OR=1.238, 95% CI: 1.002-1.193, P=0.021), longer duration of diabetes (OR=1.265, 95% CI: 1.116-1.384, P=0.016), and longer duration of intravenous thrombolysis(OR=1.105, 95% CI: 1.067-1.356, P=0.010) were associated with cognitive impairment 30 days after intravenous thrombolysis independent risk factors. Conclusion Shortening the time of intravenous thrombolysis after onset may help reduce patient' early cognitive impairment in patients with acute mild ischemic stroke, and transient ischemic attack.
- Acute mild ischemic stroke /
- Transient ischemic attack /
- Intravenous thrombolysis /
- Cognitive impairment

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表 1 2组脑梗死患者基线特征比较

Table 1. Comparison of NIHSS scores between two groups of patients with cerebral infarction

项目	认知障碍组(n=100)	非认知障碍组(n=56)	统计量	P值
性别(男/女，例)	39/61	20/36	0.047^a	0.827
年龄(x±s，岁)	66.7±1.2	59.8±2.6	2.627^b	0.037
基线NIHSS评分[M(P₂₅, P₇₅), 分]	4(0，6)	3(0，5)	725.000^c	0.211
心血管疾病[例(%)]	4(4.0)	4(7.1)	6.787^a	0.079
心房颤动史[例(%)]	21(21.0)	6(10.7)	2.568^a	0.109
受教育时间(x±s，年)	3.0±0.4	4.9±0.9	2.682^b	0.011
高血压病病程(x±s，年)	7.9±1.0	4.2±1.0	2.006^b	0.036
糖尿病病程(x±s，年)	6.2±0.9	1.4±0.7	3.309^b	0.003
总蛋白(x±s，g/L)	64.6±1.0	67.6±1.0	0.654^b	0.705
白蛋白(x±s，g/L)	37.0±0.4	40.0±1.4	2.896^b	0.098
同型半胱氨酸(x±s，μmol/L)	15.1±1.7	13.9±0.7	0.425^b	0.249
总胆固醇(x±s，mmol/L)	4.7±0.1	4.5±0.2	2.103^b	0.040
高密度脂蛋白胆固醇(x±s，mmol/L)	0.7±0.1	1.2±0.1	0.209^b	0.904
低密度脂蛋白胆固醇(x±s，mmol/L)	2.4±0.2	2.4±0.1	0.651^b	0.395
尿酸(x±s，μmol/L)	336.8±16.7	322.1±9.0	0.402^b	0.164
发病到静脉溶栓时间(x±s，min)	233.9±27.6	102.8±10.2	2.645^b	0.017
梗死体积[M(P₂₅, P₇₅)，mL]	8.3(2.1，28.6)	3.6(1.7，29.5)	527.400^c	0.011
梗死部位[例(%)]			6.843^a	0.033
皮层	29(29.0)	7(12.5)
皮层下	55(55.0)	42(75.0)
皮层和皮层下	16(16.0)	7(12.5)
注：^a为χ²值, ^b为t值, ^c为U值。

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表 2 2组脑梗死患者NIHSS评分结果比较[M(P₂₅, P₇₅), 分]

Table 2. Comparing two groups of patients with cerebral infarction NIHSS score results [M(P₂₅, P₇₅), points]

组别	例数	溶栓用药时	溶栓后30 d
认知障碍组	100	4(0，6)	2(0，4)
非认知障碍组	56	3(0，4)	2(0，3)
U值		1 079.615	1 187.348
P值		0.067	0.118

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表 3 发病30 d发生认知障碍相关影响因素的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of cognitive impairment at 30 days after onset

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.088	0.523	7.745	0.006	1.092	1.031~1.577
受教育时间	-0.024	0.033	0.542	0.461	0.976	0.915~1.041
心血管疾病	0.432	0.455	0.759	0.385	1.541	0.108~11.645
心房颤动	0.583	0.368	3.644	0.059	1.792	0.108~11.645
高血压病程	0.191	0.524	7.735	0.021	1.238	1.002~1.193
糖尿病病程	1.823	0.694	6.856	0.016	1.265	1.116~1.384
白蛋白	0.994	0.087	1.054	0.327	2.703	0.158~12.472
总胆固醇	-0.801	0.338	3.644	0.057	0.449	0.247~1.332
发病到静脉溶栓时间	0.266	2.821	6.548	0.010	1.105	1.067~1.356
梗死体积	1.035	0.547	7.951	0.003	2.814	1.902~5.827
梗死部位
(皮层下vs.皮层)	-0.199	0.137	2.124	0.145	0.819	0.627~1.071
(皮层、皮层下均有vs.皮层)	1.545	0.688	0.238	0.648	4.690	0.901~24.077

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参考文献(31)

[1]	MURHPY M P, CORRIVEAU R A, WILCOCK D M. Vascular contributions to cognitive impairment and dementia(VCID)[J]. Biochim Biophys Acta, 2016, 1862(5): 857-859. doi: 10.1016/j.bbadis.2016.02.010
[2]	ZLOKOVIC B V, GOTTESMAN R F, BERNSTEIN K E, et al. Vascular contributions to cognitive impairment and dementia (VCID): a report from the 2018 National Heart, Lung and Blood Institute and National Institute of Neurological Disorders and Stroke Workshop[J]. Alzheimers Dement, 2020, 16(12): 1714-1733. doi: 10.1002/alz.12157
[3]	KALARIA R N, AKINYEMI R, IHARA M. Stroke injury, cognitive impairment and vascular dementia[J]. Biochim Biophys Acta, 2016, 1862(5): 915-925. doi: 10.1016/j.bbadis.2016.01.015
[4]	MIJAJLOVIC M D, PAVLOVIC A, BRAININ M, et al. Post-stroke dementia-a comprehensive review[J]. BMC Med, 2017, 15(1): 11. doi: 10.1186/s12916-017-0779-7
[5]	ZUO L, DONG Y, ZHU R, et al. Screening for cognitive impairment with the Montreal Cognitive Assessment in Chinese patients with acute mild stroke and transient ischaemic attack[J]. BMJ Open, 2016, 6(7): e011310. DOI: 10.1136/bmjopen-2016-011310.
[6]	KIM D H, LEE D S, NAH H W, et al. Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke[J]. BMC Neurol, 2018, 18(1): 30. doi: 10.1186/s12883-018-1033-4
[7]	HAEBERLIN M I, HELD U, BAUMGARTNER R W, et al. Impact of intravenous thrombolysis on functional outcome in patients with mild ischemic stroke without large vessel occlusion or rapidly improving symptoms[J]. Int J Stroke, 2020, 15(4): 429-437. doi: 10.1177/1747493019874719
[8]	WANG X H, TAO L, ZHOU Z H, et al. Antiplatelet vs. R-tPA for acute mild ischemic stroke: a prospective, random, and open label multi-center study[J]. Int J Stroke, 2019, 14(6): 658-663. doi: 10.1177/1747493019832998
[9]	WANG G F, ZHAO X, LIU S P, et al. Efficacy and safety of mechanical thrombectomy for acute mild ischemic stroke with large vessel occlusion[J]. Med Sci Monit, 2020, 26: e926110. DOI: 10.12659/MSM.926110.
[10]	XIONG Y, YAN R, GU H, et al. Intravenous thrombolysis in Chinese patients with mild acute ischemic stroke[J]. Ann Transl Med, 2021, 9(9): 76.
[11]	ROMANO J G, GARDENER H, CAMPO-BUSTILLO I, et al. The mild and rapidly improving stroke study (MaRISS): rationale and design[J]. Int J Stroke, 2019, 14(9): 983-986. doi: 10.1177/1747493019873595
[12]	ROSENBAUM HALEVI D, BURSAW A W, KARAMCHANDANI R R, et al. Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt-PA[J]. Ann Clin Transl Neurol, 2019, 6(3): 466-474. doi: 10.1002/acn3.719
[13]	CIESIELSKA N, SOKOLOWSKI R, MAZUR E, et al. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis[J]. Psychiatr Pol, 2016, 50(5): 1039-1052. doi: 10.12740/PP/45368
[14]	SENDA M, TERADA S, TAKENOSHITA S, et al. Diagnostic utility of the Addenbrooke ' s Cognitive Examination-Ⅲ(ACE-Ⅲ), Mini-ACE, Mini-Mental State Examination, Montreal Cognitive Assessment, and Hasegawa Dementia Scale-Revised for detecting mild cognitive impairment and dementia[J]. Psychogeriatrics, 2020, 20(2): 156-162. doi: 10.1111/psyg.12480
[15]	LI H, JIA J, YANG Z. Mini-mental state examination in elderly Chinese: a population-based normative study[J]. J Alzheimers Dis, 2016, 53(2): 487-496. doi: 10.3233/JAD-160119
[16]	SUN H, LIU Y, GONG P, et al. Intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign: a meta-analysis[J]. Acta Neurol Scand, 2020, 141(3): 193-201. doi: 10.1111/ane.13177
[17]	THOMALLA G, BOUTITIE F, MA H, et al. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: Systematic review and meta-analysis of individual patient data[J]. Lancet, 2020, 396(10262): 1574-1584. doi: 10.1016/S0140-6736(20)32163-2
[18]	GRIESSENAUER C J, MEDIN C, MAINGARD J, et al. Endovascular mechanical thrombectomy in large-vessel occlusion ischemic stroke presenting with low national institutes of health stroke scale: systematic review and Meta-analysis[J]. World Neurosurg, 2018, 110: 263-269. doi: 10.1016/j.wneu.2017.11.076
[19]	LEE V H, THAKUR G, NIMJEE M S, et al. Early neurologic decline in acute ischemic stroke patients receiving thrombolysis with large vessel occlusion and mild deficits[J]. Neurointerv Surg, 2020, 12(11): 1085-1087. doi: 10.1136/neurintsurg-2020-015871
[20]	KIM D H, LEE D S, NAH H W, et al. Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke[J]. BMC Neurol, 2018, 18(1): 30. doi: 10.1186/s12883-018-1033-4
[21]	REIFF T, MICHEL P. Reasons and evolution of non-thrombolysis in acute ischemic stroke[J]. Emerg Med J, 2017, 34(4): 219-226. doi: 10.1136/emermed-2015-205140
[22]	MAHON S, PARMAR P, BARKER-COLLO S, et al. Determinants, prevalence, and trajectory of long-term post-stroke cognitive impairment: results from a 4-year follow-up of the ARCOS-Ⅳ study[J]. Neuroepidemiology, 2017, 49(3-4): 129-134. doi: 10.1159/000484606
[23]	KAPOOR A, LANCTOT K L, BAYLEY M, et al. "Good Outcome" isn ' t good enough: cognitive impairment, depressive symptoms, and social restrictions in physically recovered stroke patients[J]. Stroke, 2017, 48(6): 1688-1690. doi: 10.1161/STROKEAHA.117.016728
[24]	YANG Y, YE L, LIN R, et al. Neuropsychological and neuroimaging assessments of early cognitive impairment in patients after mild ischemic stroke and transient ischemic attack[J]. J Integr Neurosci, 2020, 19(2): 313-319. doi: 10.31083/j.jin.2020.02.14
[25]	KALARIA R N, AKINYEMI R, IHARA M. Stroke injury, cognitive impairment and vascular dementia[J]. Biochim Biophys Acta, 2016, 1862(5): 915-925. doi: 10.1016/j.bbadis.2016.01.015
[26]	沈和平, 王耿焕, 尹汉奎. 弥漫性轴索损伤认知功能障碍的临床特点及影响因素分析[J]. 中华全科医学, 2020, 18(2): 246-248. doi: 10.16766/j.cnki.issn.1674-4152.001216 SHEN H P, WANG G H, YIN H K. Clinical characteristics and relative factors of cognitive dysfunction in diffuse axonal injury[J]. Chinese Journal of General Practice, 2020, 18(2): 246-248. doi: 10.16766/j.cnki.issn.1674-4152.001216
[27]	毛新峰, 赵育英, 姚丽娣, 等. 三维动脉自旋标记在重度OSAS患者脑白质灌注异常及认知功能障碍的研究[J]. 中华全科医学, 2019, 17(6): 1004-1007. doi: 10.16766/j.cnki.issn.1674-4152.000848 MAO X F, ZHAO Y Y, YAO L D, et al. Study of three dimensiona arterial spin labeling in white matter perfusion change and cognitive impairment of patients with severe OSAS[J]. Chinese Journal of General Practice, 2019, 17(6): 1004-1007. doi: 10.16766/j.cnki.issn.1674-4152.000848
[28]	GOTTESMAN F R, HILLIS E A. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke[J]. Lancet Neurol, 2010, 9(9): 895-905. doi: 10.1016/S1474-4422(10)70164-2
[29]	BARBA R, MARTINEZ-ESPINOSA S, RODRIGUEZ-GARCIA E, et al. Poststroke dementia: clinical features and risk factors[J]. Stroke, 2000, 31(7): 1494-1501. doi: 10.1161/01.STR.31.7.1494
[30]	DARADKEH G, ESSA M M, Al-ADAWI S S, et al. Nutritional status and cognitive impairment in elderly[J]. Pak J Biol Sci, 2014, 17(10): 1098-1105. doi: 10.3923/pjbs.2014.1098.1105
[31]	HU F, LIU H, LIU X, et al. Nutritional status mediates the relationship between sarcopenia and cognitive impairment: findings from the WCHAT study[J]. Aging Clin Exp Res, 2021, 33(12): 3215-3222. doi: 10.1007/s40520-021-01883-2