Effect Of Sequential Butylphthalide Therapy On Acute Ischemic Stroke And Multivariate Analysis Of Cognitive Impairment After Stroke

Objectives:To explore the effect of butylphthalide sequential therapy on post-stroke cognitive impairment(PSCI)in acute ischemic stroke(AIS),and to analyze the risk factors related to the incidence of PSCI.We aimed to provide a basis for the clinical choice of AIS brain protection therapy and the prevention and treatment of PSCI.Methods:From January 2019 to October 2020,104 patients with AIS admitted to the Department of Neurology,First Affiliated Hospital of Kunming Medical University,were collected.According to whether butylphthalide was used or not,they were divided into the non-butylphthalide treatment group and the butylphthalide treatment group(sequential butylphthalide therapy).General demographic and medical history data of all patients were collected;the Beijing version of the Montreal Cognitive Assessment(MoCA)scale,the Internet-based continuous visual recognition task MemTrax test(MTX),the National Institutes of Health Stroke Scale(NIHSS)score,and the modified Rankin Scale(mRS),Hamilton Depression Scale(17 items)(HAMD-17)and Hamilton Anxiety Scale(HAMA)were evaluated at the time of admission and on the 90th day of treatment;multivariate Logistic regression was used to determine the independent risk factors for PSCI in AIS patients.To evaluate the effect of sequential butylphthalide treatment on the incidence of PSCI in AIS patients.Results:Among the 104 patients with AIS in this study,47 were treated with butylphthalide(the butylphthalide treatment group)and 57 were treated with butylphthalide(the non-butylphthalide treatment group).There were statistically significant differences such as education level,history of drinking,history of hypertension,and history of atrial fibrillation(all P<0.05).Logistic regression analysis found that high education level(OR=0.246,95%CI 0.078～0.774),treatment with butylphthalide(OR=0.104,95%CI 0.023～0.468),and the baseline accuracy rate of MTX>80%(OR=0.109,95%CI 0.024～0.502),is a protective factor for post-stroke cognitive impairment;as well as the number of previous cerebral infarctions>1 increases the risk of cognitive impairment(OR=7.774,95%CI 1.666～36.270).The fitting smooth curve integrating multiple factors shows that when the accuracy of MTX is greater than 85%,the risk of subsequent PSCI is predicted to be extremely low.Multivariate analysis found that compared with the non-butylphthalide treatment group,the risk of PSCI was reduced by about 89.6%(OR=0.104,95%CI 0.023～0.468)after using butylphthalide.Univariate analysis found that on the 90th day of treatment,the incidence of PSCI in the non-butylphthalide treatment group was 65.9%,and the incidence of PSCI in the butylphthalide treatment group was 38.3%.The difference in the incidence of PSCI between the two groups was statistically significant(P<0.001).The day 90 of MoCA score in the butylphthalide treatment group increased when compared to baseline,while the day 90 of NIHSS score and mRS score decrised when compared to baseline.The difference between the two groups in the MoCA,NIHSS,and mRS score change was statistically significant between the two groups(all P<0.05).The stratified analysis showed that compared with the non-butylphthalide treatment group,the butylphthalide treatment group on the 90th day has shown advantages in the prevention of PSCI in AIS patients among different ages,different levels of education,mental or physical workers,with or without a history of hypertension,history of diabetes,whether the history of stroke was more than once,baseline MTX,MoCA,and NIHSS scores,and when to use neuroprotective agents treatment.The multivariate analysis of the butylphthalide treatment group found that the number of previous cerebral infarctions>1(OR=139.572,95%CI 2.526～7711.486)and NIHSS score>2(OR=16.795,95%CI 1.132～248.1 87)were independent risk factors for PSCI.There was no statistically significant difference in the time window of butylphthalide(within 48 hours and more than 48 hours after the onset)on the risk of PSCI(P=0.548).Conclusions:The low education level of patients with AIS,the number of previous cerebral infarctions>1,and the baseline MTX accuracy rate ≤80%are independent risk factors for the incidence of PSCI;compared with other brain protecting agents,the use of butylphthalide in the acute phase of patients with AIS can reduce the risk of PSCI by 89.6%.The baseline MTX accuracy rate>85%predicted a low risk of PSCI in the future.Sequential treatment of butylphthalide in patients with AIS in the acute phase(within 2 weeks)can improve the symptoms of neurological deficits and cognitive status,and reduce the incidence of PSCI.The butylphthalide treatment in AIS patients,whether the time of the first dose was within 48 hours or not,would reduce the risk of subsequent PSCI.