合并颅内外大动脉狭窄对超急性期脑梗死静脉溶栓的影响

Influence of large artery stenosis on intravenous thrombolysis at hyperacute stage of cerebral infarction

目的探讨是否合并大动脉狭窄对多模式MRI指导的超急性期脑梗死重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓疗效的影响。方法选择发病12 h内头颅CT阴性且多模式MRI筛选符合超急性期脑梗死溶栓标准的198例脑梗死病人,给予rt-PA(0.9 mg/kg)静脉溶栓治疗,采用美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)及90 d改良Rankin评分(mRS),评定溶栓治疗前与治疗后的神经功能。结果颅内外大动脉狭窄67例,溶栓治疗后7 d和90 d NIHSS评分预后良好分别为42例(62.7%)和45例(67.2%);大动脉无狭窄131例,7 d和90 d NIHSS评分疗效良好分别为79例(60.3%)和105例(80.2%),两组溶栓后7 d预后良好率无统计学意义(P>0.05)。两组神经功能评分均为90 d优于7 d时间点(P<0.05);90 d NIHSS评分、BI指数及mRS评分良好率无狭窄组均优于狭窄组(P<0.01)。结论 MRI指导的颅内外大动脉狭窄与无颅内外大动脉狭窄的超急性期脑梗死静脉溶栓均安全有效,但合并大动脉狭窄病例90 d预后较无狭窄病例差。

Objective To explore the influence of large artery stenosis on the efficacy of magnetic resonance imaging （MRI）-guided intravenous thrombolysis with recombinant tissue plasminogen activator （rt-PA） for hyperacute cerebral infarction. Methods A total of 198 patients with hyperacute cerebral infarction were analyzed. All the patients showed normal CT scan within 12 h after symptom onset and met multimodality MRI criteria and were administered with intravenous rt-PA （0.9 mg/kg）. The nerve function was assessed before and after treatment using National Institutes of Health Stroke Scale （NIHSS） score, Barthel Index （B1） and Modified Rankins Score （mRS） on the 90th day. Results Sixty-seven patients with large artery stenosis received rt-PAtherapy and 42（62.7% ）got good prognosis assessed by NIHSS score on 7th day and 45 （67,2%） on 90th day. One hundred and thirty-one patients without large artery stenosis received rt-PA therapy and 79 （60.3%） got good prognosis assessed by NIHSS score on 7th day and 105 （80.2%） on 90th day. There was no statistical difference in prognosis between the patients with and without large artery stenosis 7th day after receiving rt-PA therapy （P 〉 0.05）. The neurologic functional score was higher at the 90th day than the 7th day in both the patients with and without large artery stenosis （P 〈 0.05）. The NIHSS, BI and mRS at the 90th day were better in the patients without large artery stenosis than in the patients with large artery stenosis （P 〈 0.01）. Conclusions Intravenous thrombolysis with rt-PA under MRI guidance within 12 hours after symptom onset is safe and effective for hyperacute cerebral infarction. The prognosis can be poorer in patients.with large artery stenosis than in those without larger artery stenosis at 90th day.