Department of Neurology, Zhengzhou People's Hospital, Zhengzhou, China.
Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, China.
Brain Behav. 2023 Dec;13(12):e3283. doi: 10.1002/brb3.3283. Epub 2023 Oct 17.
Patients with a single subcortical infarction (SSI) in the territory of the middle cerebral artery (MCA) often experience early neurological deterioration (END) despite receiving intravenous thrombolytic therapy (IVT). In this study, predictors of END were investigated in patients with SSI in the MCA after IVT.
Patients with SSI in the MCA territory who had received IVT between June 2020 and 2022 were included. END was defined as an increase in the total National Institutes of Health Stroke Scale (NIHSS) score by ≥2 or in the motor NIHSS score by ≥1 within the first 72 h of admission. Patients with proximal (pSSI) and distal SSI (dSSI) were analyzed to determine SSI type-specific predictors for END.
We evaluated 174 patients with SSI in the MCA territory who underwent IVT. Multivariable logistic regression analysis showed that pSSI (odds ratio [OR] = 0.242; 95% confidence interval [CI], 0.104-0.564; p = .001), lower high-density lipoprotein cholesterol (HDL-C) (OR = 0.150; 95% CI, 0.033-0.682; p = .014), higher blood glucose (OR = 0.858; 95% CI, 0.752-0.979; p = .023), and higher red blood cells count (OR = 1.966; 95% CI, 1.154-3.349; p = .013) were risk factors for END. In patients with pSSI, HDL-C and blood glucose were associated with END. No variable related to END was found in the dSSI group.
The proportion of END in patients with SSI in the MCA territory after IVT was not low; therefore, pSSI, HDL-C, blood glucose, and red blood cells should be monitored closely. The frequency and predictors of SSI in the MCA territory differed between pSSI and dSSI.
接受静脉溶栓治疗（IVT）后，大脑中动脉（MCA）区域单发皮质下梗死（SSI）的患者常发生早期神经功能恶化（END）。本研究旨在探讨 IVT 后 MCA 区域 SSI 患者发生 END 的预测因素。
纳入 2020 年 6 月至 2022 年期间接受 IVT 的 MCA 区域 SSI 患者。END 定义为入院后 72 小时内 NIHSS 总分增加≥2 分或运动 NIHSS 评分增加≥1 分。分析近端 SSI（pSSI）和远端 SSI（dSSI）患者，以确定 END 的 SSI 类型特异性预测因素。
共评估了 174 例接受 IVT 的 MCA 区域 SSI 患者。多变量逻辑回归分析显示，pSSI（比值比 [OR] 0.242；95%置信区间 [CI] 0.104-0.564；p 0.001）、低高密度脂蛋白胆固醇（HDL-C）（OR 0.150；95%CI 0.033-0.682；p 0.014）、高血糖（OR 0.858；95%CI 0.752-0.979；p 0.023）和高红细胞计数（OR 1.966；95%CI 1.154-3.349；p 0.013）是 END 的危险因素。在 pSSI 患者中，HDL-C 和血糖与 END 相关。dSSI 组未发现与 END 相关的变量。
IVT 后 MCA 区域 SSI 患者的 END 发生率不低；因此，应密切监测 pSSI、HDL-C、血糖和红细胞。pSSI 和 dSSI 患者 MCA 区域 SSI 的发生率和预测因素不同。
