重组组织型纤溶酶原激活物静脉溶栓治疗急性缺血性卒中——单中心回顾性研究

Intravenous recombinant tissue plasminogen activator for acute ischemic stroke ——a single center retrospective study

目的评价重组组织型纤溶酶原激活物（recombinant tissue plasminogen activator，rtPA）静脉溶栓治疗急性缺血性卒中的临床疗效和安全性，探讨溶栓时间窗和影响溶栓转归的相关因素。方法回顾性分析急性缺血性卒中患者94例，其中rtPA组40例，对照组54例。在发病后24h应用美国国立卫生院卒中量表（National Institute of Health Stroke Scale，NIHSS）评价神经功能。早期神经功能改善定义为人院后24hNIHSS改善i〉4分或神经功能完全恢复。在发病后14d应用改良Rankin量表（modified Rankin Scale，mRS）、Barthel指数（Barthel Index，BI）和NIHSS进行临床疗效评价，BI≥95分、mRS_〈1分或NIHSS≤1分定义为转归良好。此外，对有症状颅内出血（symptomatic intracranial hemorrhage，sICH）发生率和病死率进行评价。结果rtPA组24h早期神经功能改善率显著高于对照组（37．5％对13．0％，OR=3．900，P=0．007），rtPA组入院后14d转归良好率显著高于对照组（OR=2．654，95％C11．089～7．235；P=0．035）。rtPA组住院期间sICH发生率较对照组显著增高（15．00％对1．85％，P=0．033），但病死率无显著差异（17．50％对9．36％，P=0．054）。多因素回归分析显示，血糖≥8mmol／L、基底动脉梗死、NHISS评分〉／20分和存在早期CT梗死征象是转归较差的独立预测因素。3h内静脉溶栓的转归良好率显著高于4．5～6h溶栓时（47．1％对16．7％，OR=4．473，P=0．034）。结论急性缺血性卒中患者在发病6h内进行rtPA静脉溶栓治疗安全、有效，其中起病3h内溶栓的疗效更好。血糖≥8mmol／L、基底动脉梗死、NHISS评分≥20分和存在早期CT梗死征象是转归转差的独立预测因素。

Objective To assess the clinical efficacy and safety of intravenous recombinant tissue plasminogen activator （rtPA） in the treatment of acute ischemic stroke and to investigate the thrombolytic time window and the related factors affecting the prognosis of thrombolysis. Melahods Ninety-four patients with acute ischemic stroke （40 patients in the rtPA group, 54 patients in the control group）were alyzed retrospectively. The National Institute of Health Stroke Scale （NIHSS） was used to assess neurological function at 24 hours after onset. Early neurological improvement was defined as NIHSS improvement ≥4 or the neurological function recovered completely 24 hours after admission, The patients were assessed by the modified Ranldn Scale （mRS）, and the clinical efficacy was assessed by the Barthel Index 03I） and NIHSS. Good outcome was defined as BI ≥95, mRS ≤1 or NIHSS ≤1. In addition, the incidence and mortality of the symptomatic ilm^rmial hemorrhage （slCH） were assessed. Results The rate of early neurological improuercent at 24 hours in the rtPA group was significantly higher than that in the control group （37. 5% vs. 13.0%, OR = 3.900; P = 0. 007）. The rate of good outcorne at day 14 after admission in the rtPA group was significantly higher than that in the control group （OR =2. 654, 95% CI 1.089-7. 235, P =0. 035）. The incidence of slCH in the rtPA group during the hospitalization was significantly higher than that in the control group （15.00% vs. 1.85%, P =0. 033）, howe^r, there was no significant difference in mortality （17. 50% vs. 9. 36%, P =0. 054）. The multivariate regression analysis indicated that the senan glucose ≥ 8 mmol/L, basilar artery occlusion, NIHSS score ≥ 20, and an early sign of infarction on CT were the independent predicting factors for poor outcome; the rate of good outcome of intrauenous thrombolysis within 3 h was significantly higher than that in the 4. 5 to 6 h thrombolytic group （47. 1% vs. 16. 7%, P = 0. 034）. Conclusions q-hrombolysis treatment with intrauenous rtPA within 6 h after the onset was safe and effective for patients with acute ischemic stroke, in which the efficacy of intrvnous thrombolysis was better within 3 h. qhe serum glucose ≥8 mmol/L, basilar artery occlusion, NIHSS score ≥20, and an early sign of infarction on cr were the independent predicting factors for poor outcome.