轻型缺血性脑卒中静脉溶栓的临床结局及影响因素

Outcomes in mild acute ischemic stroke treated with intravenous thrombolytic treatment and their influencing factor

目的:本研究旨在分析轻型急性缺血性脑卒中患者组织型纤溶酶原激活物(tPA)静脉溶栓后近期、远期的有效性和安全性结局情况,并探讨与溶栓后不良临床结局相关的影响因素。方法:本研究的入选患者来自中国急性缺血性脑卒中溶栓监测登记研究(TIMS-China),回顾性选取发病4.5h内且基线美国国立卫生院卒中量表(NIHSS)评分≤5分的轻型急性缺血性脑卒中患者,分析这些患者溶栓后2h、24h、90d的有效性、安全性结局情况及影响因素。主要安全性结局评价指标为溶栓后24~36h的症状性颅内出血(SICH)及溶栓后90d患者死亡情况;主要有效性结局评价指标为溶栓后90d的改良Ranking量表(mRS)评分,良好预后定义为mRS 0~1分,不良预后定义为mRS 2~6分。结果:共入选174例患者,结果显示溶栓后2h和24h症状改善(NIHSS减少≥1)的比例分别为54.60%和67.24%,而90d时mRS 0~1分的比例为79.89%。90d时病死率为1.15%,SICH的发生率根据不同定义,为0.57%~1.15%。结局良好组与结局不良组的基线情况比较,仅既往卒中史差异有统计学意义(P<0.05)。结论:轻型缺血性脑卒中患者静脉溶栓后的近期、远期的预后均较好,出血风险很低,有既往卒中史与轻型缺血性脑卒中溶栓后不良临床结局相关。

Objective：To analyses the short-term and long-term outcomes in mild acute ischemic patients received intravenous thrombolytic treatment.And to investigate the influencing factors associated with adverse clinical outcomes after thrombolysis. Method：Mild acute ischemic stroke patients received intravenous thrombolytic treatment within 4.5 htime window and with a baseline National Institutes of Health Stroke Scale score（NIHSS）of 5 or less were included.The efficacy,safety outcome and influencing factors of 2 h,24 hand 3 mafter thrombolysis were analyzed.The Main safety outcome measures were symptomatic intracranial hemorrhage（SICH）at 24 to 36 hours after thrombolytic therapy and mortality at 3 months.Main efficacy outcome was the modified Rankin scale（mRS）at 3 months.Excellent recovery was defined as mRS 0-1,and poor prognosis was defined as mRS 2-6.Result：Total 174 patients were included.The rates of symptom improved（NIHSS reduced≥1）at2 hand 24 hafter thrombolytic treatment were 54.60% and 67.24%.79.89% of patients got excellent recovery（mRS 0-1）at 3 m.And the mortality rate was 1.15% at 3 m.The rates of SICH were 0.57%~1.15% as different definition.Only the history of stroke was significantly different between excellent recovery group and non-excellent recovery group（P〈0.05）.Conclusion：The short-term and long-term outcomes in mild acute ischemic patients received intravenous thrombolytic treatment were both good and the SICH rate was low.The history of stroke was related to non-excellent recovery outcome.