目的 探討阿加曲班對(duì)輕中度急性缺血性腦卒中患者的早期神經(jīng)功能恢復(fù)的改善情況；并對(duì)不同卒中亞型的療效進(jìn)行比較，對(duì)阿加曲班療效的影響因素進(jìn)行相關(guān)性分析。方法 根據(jù)納入及排除標(biāo)準(zhǔn)收集2019年12月1日—2021年6月1日新疆軍區(qū)總醫(yī)院收治的急性非心源性輕中度急性缺血性腦卒中患者，按照患者是否使用阿加曲班治療作為分組的依據(jù)，390例入選患者分為阿加曲班組（285例）和未使用阿加曲班的對(duì)照組（105例），收集兩組患者性別、年齡、高血壓、糖尿病、冠心病、既往卒中史、吸煙史等基線資料，收集治療前后患者低密度脂蛋白膽固醇（LDL-C）、高密度脂蛋白膽固醇（HDL-C）、三酰甘油（TG）、總膽固醇（TC）、抗血小板藥物使用情況、入院時(shí)及治療7 d時(shí)美國(guó)國(guó)家衛(wèi)生研究院卒中量表（NIHSS）評(píng)分和改良Rankin量表（mRS）評(píng)分及卒中病因分型等數(shù)據(jù)。卒中分型診斷標(biāo)準(zhǔn)按中國(guó)缺血性卒中亞型（CISS）分型。以住院第7天時(shí)NIHSS評(píng)分和mRS評(píng)分為療效指標(biāo)，進(jìn)行相關(guān)性分析。結(jié)果 阿加曲班組與對(duì)照組患者年齡，高血壓、糖尿病、既往卒中、冠心病患病人數(shù)，吸煙史，LDL-C、HDL-C、TC、TG水平，入院時(shí)NIHSS評(píng)分，服用抗血小板藥物種類等基線資料組間比較，差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05），兩組間治療7 d時(shí)NIHSS評(píng)分、治療7 d時(shí)NIHSS評(píng)分變化、治療7 d時(shí)mRS評(píng)分、大動(dòng)脈粥樣硬化型例數(shù)、穿支動(dòng)脈病變型例數(shù)差異有統(tǒng)計(jì)學(xué)差異（P＜0.05），在大動(dòng)脈粥樣硬化型亞組中，兩組間年齡、入院時(shí)NIHSS評(píng)分、治療7 d時(shí)NIHSS評(píng)分變化差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；在穿支動(dòng)脈病變型亞組中，兩組間入院時(shí)NIHSS評(píng)分、治療7 d時(shí)NIHSS評(píng)分差異有統(tǒng)計(jì)學(xué)意義（P＜0.05），治療7 d時(shí)NIHSS評(píng)分改變與使用阿加曲班呈正相關(guān)，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；患有高血壓與治療7 d時(shí)NIHSS評(píng)分，冠心病史、LDL-C水平與治療7 d時(shí)mRS評(píng)分均呈正相關(guān)，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；既往卒中病史與治療7 d時(shí)NIHSS評(píng)分改變呈負(fù)相關(guān)，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論 阿加曲班可以改善非心源性輕中度急性缺血性腦卒中患者的早期預(yù)后，卒中分型、合并高血壓、冠心病史、既往卒中病史等因素對(duì)阿加曲班療效有影響。

Objective To investigate the effect of argatroban on the early recovery of neurological function in patients with mild to moderate acute ischemic stroke. The curative effects of different subtypes of stroke were compared, and the influencing factors of the curative effect of argatroban were analyzed. Methods According to the inclusion and exclusion criteria, the patients with acute non cardiogenic mild to moderate acute ischemic stroke treated in the General Hospital of Xinjiang Military Region from December 1, 2019 to June 1, 2021 were collected. According to whether the patients were treated with argatroban or not, 390 patients were divided into argatroban (285 cases) and control group without argatroban (105 cases). Baseline data of two groups of patients were collected from gender, age, hypertension, diabetes, coronary heart disease, past stroke history and smoking history. Low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), three glycerol (TG), cholesterol (TC) and antiplatelet drugs were collected before and after treatment. National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score and stroke etiology classification at admission and seven days after treatment. Stroke was classified according to the Chinese ischemic stroke subtype (CISS). The NIHSS score and mRS score on the 7th day of hospitalization were used as efficacy indicators for correlation analysis. Results There were no statistically significant differences in the age, hypertension, diabetes, past stroke, coronary heart disease, smoking history, LDL-C, HDL-C, TC, TG levels, NIHSS score at admission, and the type of antiplatelet drugs used in two group (P > 0.05). There were significant differences in NIHSS score, change of the NIHSS score after seven days of treatment, mRS score, the number of cases of large atherosclerosis disease and the number of cases of perforating artery disease in two groups (P < 0.05). In the subgroup of large atherosclerosis disease, there were significant differences in age, NIHSS score at admission and NIHSS score at seven days of treatment between two groups (P < 0.05). In the subgroup of perforating artery disease, there was significant difference between the two groups in NIHSS score at admission and NIHSS score at seven days of treatment (P < 0.05). The change of NIHSS score at seven days of treatment was positively correlated with the use of argatroban (P < 0.05). The history of coronary heart disease and the level of LDL-C were positively correlated with the mRS score at seven days of treatment (P < 0.05), and the history of previous stroke was negatively correlated with the change of NIHSS score at seven days of treatment (P < 0.05). Conclusion Argatroban can improve the early prognosis of patients with non cardiogenic mild to moderate acute ischemic stroke. Stroke classification, combined hypertension, history of coronary heart disease, history of previous stroke and other factors have an impact on the efficacy of argatroban.

R971