卒中严重程度对头低位治疗急性缺血性卒中疗效的影响:基于HOPES 2试验的事后分析OA

Objective To explore the effect of stroke severity on the efficacy of head-down position therapy in acute ischemic stroke. Methods This study was a post-hoc analysis of the head-down position for acute ischemic stroke with large artery atherosclerosis(HOPES 2)trial.Enrolled patients with acute ischemic stroke were stratified by admission NIHSS score into two subgroups:6-10 points(moderately mild)and 11-16 points(moderately severe).Within each subgroup,patients received either head-down position therapy or routine position therapy.Linear regression analysis was performed to assess the effects of different treatments on the changes in NIHSS scores at 7 days(ΔNIHSS7 d)and 12 days(ΔNIHSS12 d)within each subgroup.Multivariable logistic regression analysis was used to investigate the effects of different treatments on the 90 d favorable(mRS score of 0-2)and excellent(mRS score of 0-1)outcomes outcome within each subgroup.Meanwhile,the interaction term between treatment and admission NIHSS score subgroup was included in the regression models to test for interaction. Results A total of 89 patients with acute ischemic stroke were enrolled,including 64 males,with a mean age of(62.6±11.5)years.Among them,64 patients were in the admission NIHSS score 6-10 subgroup(31 received head-down position therapy,33 received routine position therapy),and 25 patients were in the admission NIHSS score 11-16 subgroup(11 received head-down position therapy,14 received routine position therapy).For the primary outcome,there was no significant difference in the proportion of patients with a 90-day favorable outcome between head-down position therapy and routine position therapy in either subgroup.For secondary outcomes,in the admission NIHSS score 6-10 subgroup,patients receiving head-down position therapy showed greater improvement in ΔNIHSS7 d(adjusted β=-2.23,95%CI-4.81--0.35,Padjusted=0.004)and ΔNIHSS12 d(adjusted β=-2.67,95%CI-5.32--0.02,Padjusted<0.001)than those receiving routine position therapy.In the admission NIHSS score 11-16 subgroup,there was no statistically significant difference in neurological improvement between patients receiving different treatments.Early neurological deterioration at 48 hours occurred in only 2 patients(6.1%)receiving routine position therapy within the admission NIHSS score 6-10 subgroup.For 90-day all-cause mortality,in the admission NIHSS score 6-10 subgroup,there was 1 death with head-down position therapy and 3 with routine position therapy,while in the 11-16 subgroup,there were 2 deaths with routine position therapy.Interaction analysis revealed that the interaction between treatment and admission NIHSS score was not statistically significant for either the primary or secondary outcomes. Conclusions Head-down position therapy can improve early neurological impairment in patients with moderately mild acute ischemic stroke,but has no significant effect on 90-day favorable outcome.No clear benefit of head-down position therapy was observed in patients with moderately severe acute ischemic stroke.Future studies may optimize the head-down position therapy protocol and further explore its long-term benefits in patients with moderately mild acute ischemic stroke.