功能MRI指导下醒后缺血型卒中尿激酶静脉溶栓的疗效和安全性研究

Efficacy and safety of functional MRI- based intravenous thrombolysis treatment withurokinase in wake- up ischemic strokes

目的探讨在功能MRI指导下醒后缺血型卒中尿激酶静脉溶栓的有效性和安全性。方法采用1:1病例对照研究方法,选择发病至就诊时间<4 h醒后缺血型卒中患者32例为病例组,在功能MRI指导下对PWI-DWI不匹配的患者给予尿激酶静脉溶栓治疗;选择同期住院发病在4.5 h内给予尿激酶静脉溶栓的脑梗死患者32例为对照组,观察两组溶栓后24 h NIHSS评分、90 d时mRS评分及症状性颅内出血发生率。结果两组患者溶栓2 4 h NIHSS评分均明显低于溶栓前(P<0.05)。两组患者溶栓后24 h NIHSS评分(7.43±3.24 vs 7.58±3.46)和90 d的临床结局良好(mRS 0-1分)百分比比较(40.6%vs 46.9%)均无统计学意义(P>0.05)。症状性颅内出血发生率比较无统计学差异(9.4%VS 6.3%,P=0.554)。结论对发病时间<4 h的醒后缺血型卒中患者,在功能MRI指导下,对存在PWI-DWI不匹配的患者给予尿激酶静脉溶栓治疗,能够获得与4.5 h时间窗内溶栓患者同样的疗效和安全性。

Objective To investigate efficacy and safety of functional MRI-based intravenous thrombolysis treatment with urokinase in wake-up ischemic strokes （ WUIS ）. Methods In this study, 1 ： 1 case-control study method was adopted. 32 patients with WUIS, whose duration from onset to admission was less than 4 h, were selected as the case group; patients whose PWI and DWI results were mismatched were given urokinase thrombolysis by functional MRI ; 32 patients, whose duration from onset to admission was less than 4.5 h, were selected as the control group and were given urokinase thrombolysis; symptomatic intracranial bleeding, postthrombolysis 24 h NIHSS score and 90 d mRS scores were used as indicators for efficacy and safety. Results 32 cases of patients with WUS were given urokinase thrombolysis, where 13 cases （40.6% ） in the case group had good 90 d clinical outcome （mRS： 0-1 point） while 15 cases （46.9% ） in the control group had good 90 d clinical outcome. And there were no significant differences （ P〉0.05 ）. There were no significant differences between two groups of patients in baseline and post-thrombolysis 24 h NIHSS scores （ P〉0.05 }. But both of the two groups had significant differences between pre-thrombolysis NIHSS scores and post-thrombolysis 24 h NIHSS scores （P〈0105）. In the case group, 3 cases （9.4%） appeared symptomatic intracranial bleeding, but no case died ; while in the control group, 2 cases （ 6.3 % ） appeared symptomatic intracranial bleeding and no case died; there were no significant differences between two groups of patients in symptomatic intracranial hemorrhage rate （ P = 0. 554 ）. Conclusion For patients with WUIS whose onset time is less than 4 h, urokinase thrombolysis for patients with mismatching PWI-DWI results by functional MRI can obtain the same efficacy and safety as patients with thrombolysis within 4.5 h.