年龄对急性缺血性脑卒中溶栓治疗预后影响的研究

Effect of age on the prognosis of thrombolytic therapy in acute ischemic stroke

目的 探讨年龄与急性缺血性脑卒中（AIS）溶栓治疗预后的相关性.方法 114例AIS患者按年龄分为≤60岁组32例、61～ 70岁组36例和≥71岁组46例,均按照《中国急性缺血性脑卒中诊治指南2010》的标准进行溶栓及溶栓后的治疗,记录患者就诊即刻、溶栓后24 h及溶栓后7d的美国国立卫生研究院卒中量表（NIHSS）评分及溶栓后3个月改良Rankin量表（mRS）评分,并记录自发性颅内出血（sICH）及2周死亡的发生情况.结果 ≤60岁组男22例,女10例;61～70岁组男26例,女10例,≥71岁组男20例,女26例.≥71岁组女性占56.52％（26/46）,高于其他两组,差异有统计学意义（x2=0.685,P=0.015）.三组就诊即刻、溶栓后24 h、溶栓后7 dNIHSS评分比较差异均无统计学意义（P＞0.05）.三组溶栓后3个月mRS评分分别为（1±3）,（2±5）和（2±3）分,比较差异有统计学意义（P=0.040）,2周病死率及sICH发生率比较差异亦有统计学意义（P=0.049,0.017）.结论 尽管不同年龄段病死率及sICH的发生率存在差异,但重组组织型纤维蛋白酶原激活剂溶栓治疗可以显著改善不同年龄段AIS患者3个月后的神经功能缺损.

Objective To investigate the correlation between age and the prognosis of thrombolytic therapy in acute ischemic stroke （AIS）.Methods One hundred and fourteen patients with AIS were divided into ≤60 years group,61-70 years group and ≥71 years group according to age.Thrombolysis and post-thrombolysis treatment was done in accordance with 2010 version of ＂Chinese Acute Ischemic Stroke Treatment Guidelines＂ standard.The United States National Institutes of Health Stroke Scale （NIHSS） score was done in patient immediately after treatment,24 h after thrombolysis and 7 d after thrombolysis,and modified Rankin scale （mRS） score was assessed 3 months after thrombolysis The spontaneous intracranial hemorrhage （sICH） and the death of 2 weeks was recorded.Results ≤ 60 years group had 22 males and 10 females;61-70 years group had 26 males and 10 females; ≥71 years group had 20 males and 26 females.In ≥ 71 years group,women accounted for 56.52% （26/46）,which was higher than that in the other 2 groups,and there was significant difference （x2 =0.685,P =0.015）.The NIHSS score immediately after treatment,24 h after thrombolysis and 7 d after thrombolysis among 3 groups had no significant difference （P 〉 0.05）.The mRS score at the 3 months after thrombolysis among 3 groups was （1 ± 3）,（2 ± 5） and （2 ± 3） scores,respectively,and there was significant difference（P =0.040）.Mortality and incidence of sICH in 2 weeks also had significant difference （P =0.049,0.017）.Conclusions Despite the differences in the mortality and incidence of sICE among different ages,thrombolytic therapy with recombinant tissue-type plasminogen activator can significantly improve the neurological deficit after 3 months in AIS patients of different ages.