一些腔隙性脑梗死患者在发病几天内科出现临床神经功能恶化，但与腔隙性脑卒中进展有关的因素尚不明。因此，日本学者对此进行了探讨，结果表明，与急性腔隙性脑卒中早期神经功能恶化和复发的相关因素包括老年、低密度脂蛋白胆固醇(LDL-C)水平较高和初始梗死范围较大，而早期他汀干预可能预防急性腔隙性脑梗死的进展，未来还需前瞻性随机对照研究来确认他汀类药物的这种作用。

        该研究纳入了277例发病72小时内入院的连续腔隙性脑梗死患者。以美国国立卫生院神经功能缺损评分(NIHSS)增加4分及以上或腔隙性脑梗死发病30天以内症状性缺血性卒中复发定义为梗死进展(PI)。评估PI与患者特征、神经影像和急性期治疗手段的相关性。

        结果显示， PI、神经功能恶化和症状性缺血性卒中复发的患者数分别为24例、21例和3例，百分比分别为8.7%、7.6%和1.1%。

        单变量分析显示，与那些无PI的患者相比，有PI进展患者的初始梗死范围≥15 mm更多(P < 0.01)，年龄(P = 0.04)、CRP (P = 0.05)和LDL-C 水平(P = 0.04)更高。在无PI的患者中，早期他汀类药物干预显著较为频繁(41.9 对20.8%，P=0.04)，包括对患者初次启动他汀类药治疗、既往应用他汀类药物治疗的患者逐渐增加其剂量或转为高效他汀类药物治疗。早期双联抗血小板治疗或抗凝治疗与PI无关。

        多变量分析显示，年龄(OR=1.67 /10年，P= 0.02)、初始梗死范围≥15 mm (OR=5.26，P< 0.01)、LDL-C(OR=1.25 每10mg/dL，P< 0.01和他汀类药物干预(OR=0.22，P< 0.01)与PI有相关性。

        该研究于国际卒中大会(ISC2015)壁报上展示，并发表于《卒中》(Stroke)杂志增刊上。

点击进入>>>2015国际卒中大会(ISC)专题报道

        参考文献：Kazuki Fukuma. Stroke.2015; 46: TP65 International Stroke Conference Poster Abstracts

• International Stroke Conference Poster Abstracts
Session Title: Acute Nonendovascular Treatment Posters II
Abstract T P65: Early Statin Intervention Can Reduce the Early Neurological Deterioration and Recurrence in Acute Lacunar Stroke
1. Kazuki Fukuma
+Author Affiliations
1. From the Divs of Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan

Abstract
Background and Purpose: Some patients with lacunar infarction show clinical neurological deterioration within few days after the onset. However factors associated with progressive lacunar stroke are unclear. The aim of this study was to identify the factors related to early neurological deterioration and recurrence in acute lacunar stroke.
Methods: We studied 277 consecutive patients (173 men; mean age, 72 years) with a lacunar infarction admitted within 72 hours after the onset between Jan 2011 and Jul 2013. Progressive infarction (PI) was defined as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score or recurrence of symptomatic ischemic stroke within 30 days after the onset. Associations between PI and patient characteristics, neuroimaging and acute treatments were evaluated.
Results: Twenty-four of the 277 patients (8.7%) had PI, 21 patients (7.6%) presented with neurological deterioration and remaining 3 (1.1%) with symptomatic recurrence. In univariate analysis, an initial infarct extent of ≥15 mm was more frequent (P < 0.01), and age (P = 0.04), CRP (P = 0.05) and LDL-C (P = 0.04) were higher in patients with PI than those without. Early statin intervention (newly initiated statin, dose-escalation of pre-treated statin, or switching to strong statin) was significantly more frequent in patient without PI (41.9 vs 20.8%, P=0.04). Early dual antiplatelet or anticoagulant therapy was not associated with PI. In multivariate analysis, age [OR: 1.67 per 10 year; 95% CI: 1.07-2.70, p = 0.02], an initial infarct extent of ≥15 mm [OR: 5.26; 95% CI: 2.01-14.37, p < 0.01], LDL-C [OR: 1.25 per 10mg/dL; 95% CI: 1.09-1.46, p < 0.01], and statinintervention [OR: 0.22; 95% CI: 0.06-0.68, p < 0.01] were related to PI.
Conclusion: Older Age, higher LDL-C and larger initial infarct extent were related to early neurological deterioration and recurrence in acute lacunar stroke. Further, early statin intervention can reduce the progressive lacunar stroke. Prospective randomized controlled trials are needed to determine whether the early statinintervention can prevent progression in acute lacunar stroke.