高龄急性脑梗死静脉溶栓治疗的有效性和安全性分析

Efficacy and safety of intravenous thrombolysis in elderly ischemic stroke patients

目的探讨高龄急性脑梗死患者静脉溶栓治疗的有效性和安全性。方法将337例发病4.5h内接受重组组织型纤溶酶原激活物静脉溶栓治疗的急性脑梗死患者分为高龄(≥80岁)溶栓组75例和非高龄溶栓组262例。并将211例高龄急性脑梗死非溶栓治疗的患者作为高龄非溶栓组,予抗血小板聚集治疗。比较高龄溶栓组与高龄非溶栓组、非高龄溶栓组的基线资料和治疗效果,分析高龄急性脑梗死患者静脉溶栓治疗的有效性和安全性。结果高龄溶栓组患者基线NIHSS评分、症状性脑出血发生率均高于高龄非溶栓组,差异均有统计学意义(均P<0.05),两组患者90d良好预后、病死率比较差异均无统计学意义(均P>0.05)。NIHSS评分≥10分组中,高龄溶栓组患者90d良好预后优于高龄非溶栓组,差异有统计学意义(P<0.01),但两组患者症状性脑出血、病死率比较差异均无统计学意义(均P>0.05)。高龄溶栓组患者90d良好预后劣于非高龄溶栓组,且病死率高于非高龄溶栓组,差异均有统计学意义(均P<0.01),两组症状性脑出血发生率比较差异无统计学意义(P>0.05)。多因素logistic回归分析显示,高龄并非静脉溶栓90d良好预后的影响因素(OR=0.562,95%CI:0.301～1.047,P>0.05)。结论高龄不影响急性脑梗死静脉溶栓预后,神经功能缺损较重的高龄急性脑梗死患者可能从静脉溶栓中获益,且并不一定会增加症状性脑出血的发生。

Objective To explore the efficacy and safety of intravenous thrombolysis(IVT) in elderly ischemic stroke patients. Methods A total of 337 acute ischemic stroke(AIS) patients were treated with IVT. Patients were categorized into two groups according to age: those aged ≥80 years(n=75) and <80 years(n=262), 211 non-IVT elderly AIS patients receiving platelet aggregation therapy served as control group. The baseline characteristics and prognosis were compared among those groups, and the efficacy and safety of IVT in elderly AIS patients were evaluated. Results In patients aged ≥80 years, the IVT subgroup had higher National Institutes of Health Stroke Scale score(NIHSS) and symptomatic intracranial hemorrhage (sICH) than the non-IVT subgroup(both P<0.05). There were no significant differences in 90d favorable outcome and mortality between two groups(both P >0.05). The 90d favorable outcome was superior in elderly IVT patients with NIHSS≥10(P<0.01). Among all IVT patients, the elderly subgroup had lower 90d favorable outcome and higher mortality than the non-elderly subgroup(both P<0.01). The sICH was not significantly different in the two groups(P >0.05). Logistic regression analysis revealed that age ≥80 years was not an independent influencing factor for 90d favorable outcome rate(OR=0.562, 95%CI:0.301~1.047, P>0.05). Conclusion Age≥80 years does not affect the prognosis of AIS patients receiving IVT. The elderly AIS patients with severe neurologic deficits could still benefit from IVT, and may not increase the risk of sICH.