侧支循环对急性脑梗死溶栓患者预后的影响

Effect of collateral circulation on prognoses of patients with acute cerebral ischemia after thrombolysis

目的利用头颅cT血管造影（CTangiography，CTA）显示的颅内侧支循环分布状况，研究侧支循环丰富与否对大脑中动脉（middlecerebralartery，MCA）梗死患者溶栓获益和风险的影响。方法回顾性分析2014年10月1日至2016年2月1日期间南京医科大学第一附属医院收治的急性脑梗死再通治疗患者，选取其中MCA梗死并接受重组组织型纤溶酶原激活剂（recombinanttissueplasminogenactivator，rt—PA）静脉溶栓患者共49例。根据溶栓前头颅CTA显示的软脑膜吻合支分布状况，分为侧支良好组和侧支不良组，分别为31例和18例。比较两组患者30d病死率，以及两组溶栓后的获益和风险，包括溶栓后24h和30d的美国国立卫生研究院卒中量表评分（NIHSS）评分、症状性脑出血发生率。使用校正x。检验、Fisher’S精确检验或t检验进行相应的统计学分析。结果侧支良好组的30d病死率明显低于侧支不良组（0％协．16．7％，P〈0．05）；两组间溶栓后24hNIHSS评分、症状性脑出血发生率相比较差异无统计学意义（P〉0．05），而侧支良好组溶栓30d的NIHSS较侧支不良组明显降低（7．2±3．1）傩．（9．6±2．7），（P〈n05）。结论对于MCA梗死并接受静脉溶栓的患者，良好的侧支代偿可减少其病死率，并在溶栓后期获益更多，但并不减少症状性脑出血的发病风险。

Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator （rt-PA） thrombolysis for middle cerebral artery （MCA） occlusion with patients with good and poor cerebral collateral circulation. Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1, 2014 and February 1, 2016. Patients were divided into good collaterals group （ n = 31 ） and poor collaterals group （ n = 18 ） according to their distribution of leptomeningeal arteries with CTA. Thirty day mortality rate, the incidence of symptomatic intracranial hemorrhage, 24h and 30 day Stroke scores with National Institute of Health Stroke Scale （NIHSS） were compared between the two groups. Corrected chi-squared test, Fisher＇ s exact test, or t test was used to statistical analysis as appropriate. Results The 30 day mortality rate of good collaterals group wassignificantly lower than that of poor collaterals group （ 0% vs. 16. 7%, P 〈 0. 05 ） . There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups （P 〉 0. 05）, however, 30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group （7. 2 ± 3.1 vs. 9. 6 ± 2. 7, P 〈 O. 05 ） . Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis, good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis. However, good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.