阿替普酶静脉溶栓治疗急性心源性缺血性脑卒中的预后影响因素分析

Prognostic factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis

目的分析急性心源性缺血性脑卒中患者静脉溶栓治疗预后的影响因素。方法选择2013年9月至2017年9月在海军军医大学(第二军医大学)长海医院脑血管病中心接受阿替普酶静脉溶栓治疗的急性心源性缺血性脑卒中患者91例。以静脉溶栓后3个月改良Rankin量表(m RS)评分作为预后评价指标,m RS评分≤2分的患者纳入预后良好组(54例),3~6分者纳入预后不良组(37例)。分析两组患者的年龄、性别、既往史、基线美国国立卫生研究院卒中量表(NIHSS)评分、基线格拉斯哥昏迷量表(GCS)评分、溶栓前Alberta脑卒中早期计算机断层扫描评分(ASPECTS)等指标,并采用多因素logistic回归分析急性心源性缺血性脑卒中患者阿替普酶静脉溶栓治疗预后的影响因素。结果静脉溶栓后3个月预后良好率为59.3%(54/91),预后良好组和预后不良组患者的年龄[(66.57±13.46)岁vs(75.95±6.06)岁]、卵圆孔未闭患者比例[11.1%(6/54)vs 0.0%(0/37)]、基线NIHSS评分[7.5(3.5,13.0)分vs 18.0(13.0,22.0)分]、基线GCS评分[14.5(12.0,15.0)分vs 10.0(8.0,14.0)分]、溶栓前ASPECTS[10.0(9.0,10.0)分vs 9.0(8.0,10.0)分]、症状性颅内出血(SICH)发生率[1.9%(1/54)vs 32.4%(12/37)]差异均有统计学意义(t=3.964,χ~2=4.401,Z=5.235,Z=4.079,Z=2.519,χ~2=16.768;P均<0.05)。多因素logistic回归分析表明年龄[比值比(OR)=3.236,95%置信区间(CI):1.077~9.709,P=0.036]、基线NIHSS评分(OR=2.874,95%CI:1.074~6.329,P=0.034)、SICH(OR=9.346,95%CI:1.017~83.333,P=0.048)是急性心源性缺血性脑卒中静脉溶栓治疗患者预后不良的独立预测因素。结论年龄、脑卒中严重程度和SICH是影响急性心源性缺血性脑卒中静脉溶栓患者预后不良的独立预测因素。阿替普酶静脉溶栓治疗急性心源性缺血性脑卒中患者的年龄越大、脑卒中严重程度越重或发生SICH,预后越差。

Objective To explore the prognostic influencing factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis.Methods Ninety-one patients with acute cardiogenic ischemic stroke,who received intravenous thrombolysis with alteplase in Stroke Center of Changhai Hospital of Navy Medical University(Second Military Medical University)between Sep.2013 and Sep.2017,were included in this study.The modified Rankin scale(mRS)score at 3 months after thrombolysis was used as an prognostic indicator,and the patients with mRS score≤2 were good prognosis group(n=54)and those with mRS score 3-6 were poor prognosis group(n=37).The age,gender,medical history,baseline National Institutes of Health stroke scale(NIHSS)score,baseline Glasgow coma scale(GCS)score and Alberta stroke program early computed tomograghy score(ASPECTS)before thrombolysis were analyzed in each group.Multivariate logistic regression analysis was used to analyze the prognostic influencing factors.Results The good prognosis rate was 59.3%(54/91)at 3 months after thrombolysis.There were significant differences in age([66.57±13.46]years vs[75.95±6.06]years),incidence of patent foramen ovale(11.1%[6/54]vs 0.0%[0/37]),baseline NIHSS score(7.5[3.5,13.0]vs 18.0[13.0,22.0]),baseline GCS score(14.5[12.0,15.0]vs 10.0[8.0,14.0]),ASPECTS before thrombolysis(10.0[9.0,10.0]vs 9.0[8.0,10.0])and incidence of symptomatic intracranial hemorrhage(SICH,1.9%[1/54]vs 32.4%[12/37])between the good and poor prognosis groups(t=3.964,χ2=4.401,Z=5.235,Z=4.079,Z=2.519,χ2=16.768;all P<0.05).Multivariate logistic regression analysis showed that age(odds ratio[OR]=3.236,95%confidence interval[CI]1.077-9.709,P=0.036),baseline NIHSS score(OR=2.874,95%CI 1.074-6.329,P=0.034)and SICH(OR=9.346,95%CI 1.017-83.333,P=0.048)were influencing factors for poor prognosis of acute cardiogenic ischemic stroke patients treated with intravenous thrombolysis.Conclusion The age,baseline NIHSS score and SICH are independent factors for poor prognosis of patients with acute cardiogenic ischemic stroke.The patients with elder age,more serious stroke or SICH may have a worse prognosis.