替奈普酶静脉溶栓治疗穿支动脉粥样硬化病的效果观察

Efficacy of intravenous thrombolysis with tenecteplase in treating the branch atheromatous disease

目的探讨替奈普酶(TNK)静脉溶栓治疗穿支动脉粥样硬化病(BAD)的效果。方法回顾性分析2020年1月至2023年3月在郑州人民医院卒中中心住院并确诊为BAD的患者148例,根据是否应用TNK治疗,将患者分为TNK组52例,对照组96例,运用倾向性评分匹配(PSM)方法以消除TNK组和对照组患者的一般情况差异,成功匹配46例。用卒中后7 d内美国国立卫生研究院卒中量表(NIHSS)评分增加≥2分定义为早期神经功能恶化(END);用90 d改良Rankin量表(mRS)比较两组患者治疗远期效果;采用二元logistic回归模型分析BAD患者的临床结局的影响因素。结果PSM匹配后92例患者中男62例,女30例,年龄(61.0±9.5)岁;经PSM后,两组患者的出院时NIHSS评分[2(0,4)分比4(3,8)分]、住院时间[9(6,13)d比11(9,14)d]比较,差异均有统计学意义(均P<0.05)。TNK组mRS 0~2分的比例高于对照组[82.6%(38/46)比60.8%(28/46)],而END及mRS≥4分的比例均低于对照组[10.8%(5/46)比30.4%(14/46);8.7%(4/46)比26.0%(12/46)],差异均有统计学意义(均P<0.05)。对照组90 d病死率2.2%(1/46),TNK组无死亡。结论TNK静脉溶栓治疗BAD提高了90 d mRS 0~2分的比例,降低了END发生率。

Objective To explore the efficacy of intravenous thrombolysis with tenecteplase(TNK)in the treatment of branch atheromatous disease(BAD).Methods A total of 148 BAD patients hospitalized in the stroke center of Zhengzhou People′s Hospital from January 2020 to March 2023 were retrospectively included.According to whether TNK was used for treatment,the patients were divided into the TNK group(52 cases)and the control group(96 cases).The propensity score matching(PSM)method was used to eliminate baseline differences between the two groups,and 46 pairs were successfully matched.Early neurological deterioration(END)was defined as an increase in the national Institutes of Health Stroke Scale(NIHSS)scores within 7 days of stroke≥2.The 90-day modified Rankin Scale(mRS)was used to compare the long-term efficacy between the two groups.A binary logistic regression model was used to analyze the influencing factors of clinical outcomes in patients with BAD.Results Among the 92 patients,62 were males and 30 were females,with an average age of(61.0±9.5)years.After PSM,there were statistically significant differences in NIHSS score at discharge[2(0,4)vs 4(3,8)]and length of hospital stay[9(6,13)d vs 11(9,14)d](both P<0.05)between the two groups.The proportion of mRS 0-2 in TNK group was higher than that in the control group[82.6%(38/46)vs 60.8%(28/46)],while the proportion of END and mRS≥4 was lower than that in the control group[10.8%(5/46)vs 30.4%(14/46);8.7%(4/46)vs 26.0%(12/46)],with statistically significant differences(P<0.05).The 90-day mortality in the control group was 2.2%(1/46),while no death was detected in the TNK group.Conclusion Intravenous thrombolysis therapy with TNK can not only increase the proportion of 90-day mRS 0-2 in BAD patients,but also reduce the incidence of END.