Department of Neurology, Seoul National University Boramae Hospital, South Korea.
J Neurol Sci. 2011 Oct 15;309(1-2):128-30. doi: 10.1016/j.jns.2011.06.057. Epub 2011 Jul 23.
Early neurological deterioration (END) is not uncommon in lacunar stroke and may lead to poor outcome. Several predictors for END have been previously reported, however, well-designed, MRI-based studies are rare in lacunar stroke. We prospectively enrolled consecutive patients with acute lacunar infarct (≤ 48 h) confirmed by MRI to investigate possible predictors for END.
Demographic data, vascular risk factors, laboratory findings, and neurological status were obtained. END was defined as an increment of the National Institutes of Health Stroke Scale (NIHSS), ≥ 1 in motor power, or ≥ 2 in any scores during the first week.
A total of 131 patients were recruited and 17 (13%) developed END after admission. Univariate analysis revealed that diabetes, systolic blood pressure, triglyceride (TG), total cholesterol, low density lipoprotein-cholesterol, and homocysteine were associated with END. After multiple logistic regression analysis, the highest quartile of TG level (>145 mg/dL) remained independent [adjusted odds ratio (OR) = 11.46, 95% confidence interval (CI) = 1.07-122.87, P = 0.044].
Hypertriglycedemia may be a possible predictor for END in acute lacunar stroke. Thrombogenecity and microcirculatory disturbance augmented by hypertriglyceridemia may be suggested as potential mechanisms. Further studies are warranted to confirm these results. Pathophysiological and therapeutic considerations remain to be determined.
腔隙性卒中早期神经功能恶化（END）并不少见，可能导致预后不良。此前已经报道了一些 END 的预测因素，但腔隙性卒中基于 MRI 的设计良好的研究很少。我们前瞻性地招募了连续的急性腔隙性梗死（≤48 小时）患者，并通过 MRI 证实，以研究 END 的可能预测因素。
收集患者的人口统计学数据、血管危险因素、实验室检查结果和神经状态。END 定义为 NIHSS 评分增加≥1 分，或运动评分增加≥2 分，或任何评分在第一周内增加≥2 分。
共纳入 131 例患者，17 例（13%）入院后发生 END。单因素分析显示，糖尿病、收缩压、甘油三酯（TG）、总胆固醇、低密度脂蛋白胆固醇和同型半胱氨酸与 END 相关。多因素逻辑回归分析后，TG 水平最高四分位数（>145mg/dL）仍与 END 独立相关[校正优势比（OR）=11.46，95%置信区间（CI）=1.07-122.87，P=0.044]。
高甘油三酯血症可能是急性腔隙性卒中 END 的一个可能预测因素。高甘油三酯血症增强的血栓形成和微循环紊乱可能提示潜在的机制。需要进一步的研究来证实这些结果。病理生理和治疗方面的考虑仍有待确定。
