Blauenfeldt Rolf A, Hougaard Kristina D, Mouridsen Kim, Andersen Grethe
Department of Neurology, Aarhus University Hospital and Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, DenmarK.
Cerebrovasc Dis. 2017;44(1-2):88-95. doi: 10.1159/000477359. Epub 2017 May 30.
A high prestroke physical activity (PA) level is associated with reduced stroke rate, stroke mortality, better functional outcome, and possible neuroprotective abilities. The aim of the present study was to examine the possible neuroprotective effect of prestroke PA on 24-h cerebral infarct growth in a cohort of acute ischemic stroke patients treated with intravenous tPA and randomized to remote ischemic perconditioning.
In this predefined subanalysis, data from a randomized clinical trial investigating the effect of remote ischemic perconditioning (RIPerC) on AIS was used. Prestroke (7 days before admission) PA was quantified using the PA Scale for the Elderly (PASE) questionnaire at baseline. Infarct growth was evaluated using MRI (acute, 24-h, and 1-month).
PASE scores were obtained from 102 of 153 (67%) patients with a median (interquartile range) age of 66 (58-73) years. A high prestroke PA level correlated significantly with reduced acute infarct growth (24 h) in the linear regression model (4th quartile prestroke PA level compared with the 1st quartile), β4th quartile = -0.82 (95% CI -1.54 to -0.10). However, the effect of prestroke PA was present mainly in patients randomized to RIPerC, β4th quartile = -1.14 (95% CI -2.04 to -0.25). In patients randomized to RIPerC, prestroke PA was a predictor of final infarct size (1-month infarct volume), β4th quartile = -1.78 (95% CI -3.15 to -0.41).
In AIS patients treated with RIPerC, as add-on to intravenous thrombolysis, the level of PA the week before the stroke was associated with decreased 24-h infarct growth and final infarct size. These results are highly encouraging and stress the need for further exploration of the potentially protective effects of both PA and remote ischemic conditioning.
卒中前较高的身体活动（PA）水平与卒中发生率降低、卒中死亡率降低、更好的功能结局以及可能的神经保护能力相关。本研究的目的是在一组接受静脉注射组织型纤溶酶原激活剂（tPA）治疗并随机接受远程缺血预处理的急性缺血性卒中患者中，研究卒中前PA对24小时脑梗死生长的可能神经保护作用。
在这项预定义的亚分析中，使用了一项研究远程缺血预处理（RIPerC）对急性缺血性卒中（AIS）影响的随机临床试验数据。卒中前（入院前7天）PA在基线时使用老年人身体活动量表（PASE）问卷进行量化。使用磁共振成像（MRI）评估梗死灶生长情况（急性期、24小时和1个月）。
153例患者中的102例（67%）获得了PASE评分，年龄中位数（四分位间距）为66（58 - 73）岁。在直线回归模型中，卒中前较高的PA水平与急性梗死灶生长（24小时）减少显著相关（卒中前PA水平第四四分位数与第一四分位数相比），β第四四分位数 = -0.82（95%置信区间 -1.54至 -0.10）。然而，卒中前PA的作用主要存在于随机接受RIPerC的患者中，β第四四分位数 = -1.14（95%置信区间 -2.04至 -0.25）。在随机接受RIPerC的患者中，卒中前PA是最终梗死灶大小（1个月梗死灶体积）的预测因素，β第四四分位数 = -1.78（95%置信区间 -3.15至 -0.41）。
在接受RIPerC治疗的AIS患者中，作为静脉溶栓的补充，卒中前一周的PA水平与24小时梗死灶生长减少和最终梗死灶大小相关。这些结果非常令人鼓舞，并强调需要进一步探索PA和远程缺血预处理的潜在保护作用。
