多模式CT指导的觉醒型卒中rt-PA静脉溶栓对凝血因子的影响

Effects of multi-mode CT guided rt-PA intravenous thrombolysis in wake-up stroke on coagulation factors

目的多模式CT指导下，应用重组组织型纤溶酶原激活剂（recombi-nanttissueplasminogenactivator，rt-PA）治疗觉醒型卒中（wake-upstrokes，WUS），观察机体内凝血因子水平的变化及安全性评估。方法回顾分析2010年2月-2012年2月因拒绝溶栓等原因，行缺血性卒中常规治疗的20例WUS患者作为对照组。纳入2012年10月-2014年10月十堰市中西医结合医院收治的18例WUS患者，予rt-PA0．9mg／kg静脉溶栓治疗，作为溶栓组。观察治疗前，治疗后24h、7d、14d，患者血中纤维蛋白原（fibrinogen，Fib）、凝血酶原时间（prothrombintime，PT）、活化部分凝血活酶时间（activatedpartialthromboplatintime，APTT）、血小板（platelet，PI．T）水平的变化。结果治疗前2组患者Fib、PT、APTT、PLT差异无统计学意义（P〉0．05）。对照组：与治疗前相比，治疗后7d、14d，P坍水平均低于治疗前，差异有统计学意义（P〈O．05）。溶栓组：与治疗前相比，治疗后24h，PT、APTT明显延长，PLT降低，差异均有统计学意义（P〈0．05）；治疗后7d，PLT水平明显降低，治疗后14d，Fib、PLT水平均明显降低，差异均有统计学意义（P〈0．05）。治疗后14d，与对照组相比，溶栓组Fib、PLT明显降低，差异有统计学意义（P〈0．05）。2组治疗前NIHSS评分差异无统计学意义（P〉0．05）。溶栓组治疗后各时点NIHSS评分较治疗前逐渐降低，差异有统计学意义（P〈0．05）；与对照组相比，溶栓组各时点NIHSS评分均降低，差异有统计学意义（P〈0．05）。溶栓组临床结局评定的总有效率高于对照组（P〈0．01）。结论在多模式CT指导下，应用rt-PA静脉溶栓治疗WUS患者有一定疗效，凝血因子可以作为评估其安全性的指标。

Objective To observe the changes of coagulation factors and the safety after treatment of recombinant tissue type plasminogen activator （rt-PA） in wake-up stroke （WUS） patients under the guidance of multi-mode CT. Methods A total of 20 WUS patients who underwent conventional therapy from February 2010 to February 2012 for ischemic stoke due to refusal of intravenous thrombolysis were enrolled into the current study as a control group. Meanwhile, another 18 WUS patients who were admitted into our hospital from October 2012 to October 2014 were selected as an intravenous thrombolysis group and treated with 0.9 mg/kg rt-PA. Before and after 24 h, and 7 and 14 days, the changes of fibrinogen （Fib）, prothrombin time （PT）, activated partial thromboplatin time （APTF）, and platelet （PLT） were recorded and compared. Results Before treatment, no statistical difference was found as to Fib, PT, APTT and PLT between the two groups （P〉0.05）. However, the control group produced significantly lower levels of PLA 7 and 14 days after treatment than that before treatment （P〈0.05）. The intravenous thrombolysis group showed remarkably increased levels of PT and APTT and decreased levels of PLT 24 h after treatment （P〈0.05）, remarkably decreased levels of PLT 7 days after treatment, and remarkably decreased levels of Fib and PLA 14 days after treatment,compared with those before treatment （P〈0.05）. Then, compared with the control group, the intravenous thrombolysis group produced marked decreases in the amount of Fib and PLA 14 days after treatment （P〈0.05）. No statistical differences was found as to NIHSS between the two groups before treatment （P〉0.05）. The intravenous thrombolysis group presented marked lower NIHSS at each time point after treatment than those before treatment （P〈0.05）. Meanwhile, the intravenous thrombolysis group presented marked lower NIHSS at each time point after treatment than the control group （P〈0.05）. The total effective rate of clinical efficacy was higher for the intravenous thrombolysis than that for the control group （P〈0.05）. Conclusion Under the guidance of multi-mode CT, rt-PA treatment is effective for WUS patients, and coagulation factors can be used as an index for evaluation of its safety.