影响急性脑梗死静脉rt-PA溶栓早期疗效的相关因素分析

Study on the correlation factors for short-term efficacy after intravenous thrombolytic therapy

目的探讨影响重组组织型纤溶酶原激活物(rt-PA)治疗急性脑梗死早期疗效的相关因素,为临床治疗提供理论依据。方法收集2013年1月至2014年9月入住我院神经内科的82例经静脉溶栓的急性脑梗死患者的相关临床资料,根据NIHSS评分,将患者分为神经功能明显改善组(NIHSS评分降低≥4分,25例)和神经功能无改善组(NIHSS评分降低<4分或者增加,57例),并应用t检验、χ2检验和Logistic回归分析方法明确影响溶栓早期疗效的相关因素。结果本研究82例患者平均(63.29±9.82)岁,溶栓前NIHSS平均分为(12.46±7.51)分,发病到用药时间平均(170.48±62.41)min。单因素分析中,神经功能明显改善组和无改善两组高血压例数(9例vs.36例,P=0.031)、糖尿病例数(1例vs.18例,P=0.022)、发病到溶栓时间[(145.20±7.81)min vs.(183.30±8.23)min,P=0.001]之间差异有统计学意义,而多因素Logistic分析证实只有糖尿病(P=0.044,OR=8.736)和发病到溶栓时间(P=0.038,OR=1.011)在两组间差异有统计学意义,是影响疗效的独立相关因素。结论脑梗死合并糖尿病、发病时间长的患者静脉溶栓效果不佳。

Objective To examine correlation factors for short-term efficacy after intravenous thrombolytic therapy,so as to provide theoretical basis for clinical treatment. Methods A total of 82 patients hospitalized in our hospital with intravenous thrombolytic therapy including good efficacy group（ decrease in NIHSS ≥4 points,n = 25）and poor efficacy group（ decrease in NIHSS 4 points or increase,n = 57） were enrolled in this study,and related clinical data were collected from January 2013 to September 2014. The t test,χ2test and logistic regression analysis were used to find the correlation factors for efficacy. Results The average age of 82 patients was（ 63. 29 ± 9. 82） years old. The average NIHSS score before thrombolysis was 12. 46 ± 7. 51. The time from symptom onset to treatment was（ 170. 48 ± 62. 41） min. There were significant differences in the number of hypertension（ 9 vs. 36,P = 0. 031）,diabetes（ 1 vs. 18,P = 0. 022） and the time from symptom onset to treatment [（ 145. 20 ± 7. 81） min vs.（ 183. 30 ± 8. 23）min,P = 0. 001] between the good efficacy group and poor efficacy group for single factor analysis. Multiple logistic regression analysis indicated only diabetes（ P = 0. 044,OR = 8. 736） and time from symptom onset to treatment（ P =0. 038,OR = 1. 011） were correlation factors for efficacy. Conclusion The acute cerebral infarction patients complicated with diabetes and longer time from symptom onset to treatment have bad efficacy after intravenous thrombolytic therapy.