一些腔隙性腦梗死患者在發病幾天內科出現臨床神經功能惡化，但與腔隙性腦卒中進展有關的因素尚不明。因此，日本學者對此進行了探討，結果表明，與急性腔隙性腦卒中早期神經功能惡化和複發的相關因素包括老年、低密度脂蛋白膽固醇(LDL-C)水平較高和初始梗死範圍較大，而早期他汀幹預可能預防急性腔隙性腦梗死的進展，未來還需前瞻性隨機對照研究來確認他汀類藥物的這種作用。

該研究納入了277例發病72小時內入院的連續腔隙性腦梗死患者。以美國國立衛生院神經功能缺損評分(NIHSS)增加4分及以上或腔隙性腦梗死發病30天以內症狀性缺血性卒中複發定義為梗死進展(PI)。評估PI與患者特征、神經影像和急性期治療手段的相關性。

結果顯示， PI、神經功能惡化和症狀性缺血性卒中複發的患者數分別為24例、21例和3例，百分比分別為8.7%、7.6%和1.1%。

單變量分析顯示，與那些無PI的患者相比，有PI進展患者的初始梗死範圍≥15 mm更多(P < 0.01)，年齡(P = 0.04)、CRP (P = 0.05)和LDL-C 水平(P = 0.04)更高。在無PI的患者中，早期他汀類藥物幹預顯著較為頻繁(41.9 對20.8%，P=0.04)，包括對患者初次啟動他汀類藥治療、既往應用他汀類藥物治療的患者逐漸增加其劑量或轉為高效他汀類藥物治療。早期雙聯抗血小板治療或抗凝治療與PI無關。

多變量分析顯示，年齡(OR=1.67 /10年，P= 0.02)、初始梗死範圍≥15 mm (OR=5.26，P< 0.01)、LDL-C(OR=1.25 每10mg/dL，P< 0.01和他汀類藥物幹預(OR=0.22，P< 0.01)與PI有相關性。

該研究於國際卒中大會(ISC2015)壁報上展示，並發表於《卒中》(Stroke)雜誌增刊上。

點擊進入>>>2015國際卒中大會(ISC)專題報道

參考文獻：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.