80岁以上急性缺血性脑卒中患者阿替普酶静脉溶栓治疗效果及预后影响因素分析

Efficacy and safety of intravenous thrombolysis in elderly stroke patients

目的探讨80岁以上急性缺血性脑卒中患者重组组织型纤溶酶原激活剂(rt PA)阿替普酶静脉溶栓治疗的安全性、有效性及90d临床预后的影响因素。方法回顾性分析接受阿替普酶静脉溶栓治疗的201例26~90岁的急性缺血性脑卒中患者,比较≥80岁组(31例)及<80岁组(170例)的基线资料[性别、发病至静脉溶栓时间、发病前改良Rankin量表(mRS)评分、基线美国国立卫生研究院卒中量表(NIHSS)评分、吸烟史、高血压、高脂血症、房颤、冠心病、糖尿病、充血性心力衰竭、血糖、溶栓前收缩压、体重、PLT、纤维蛋白原、尿酸]及临床结局(90d mRS评分)、症状性出血转化率。分析比较≥80岁组预后良好者(90d mRS≤2分,20例)与预后不良者(90d mRS>2分,11例)的基线资料、出血风险。结果≥80岁组与<80岁组的基线资料、临床结局、出血风险差异均无统计学意义(均P>0.05)。在≥80岁组中,预后良好者与预后不良者之间的基线NIHSS评分、症状性出血转化率差异均有统计学意义(均P<0.05),其余项目比较差异均无统计学意义(均P>0.05)。结论0~4h内对80岁及以上的患者进行rt PA静脉溶栓治疗的安全性与有效性与80岁以下患者相似。基线NIHSS、症状性出血转化可能与90d临床预后不良相关。

Objective To evaluate the efficacy and safety of intravenous thrombolysis(IVT)in elderly patients with acute ischemic stroke(AIS)and to analyze risk factors for 90-day clinical outcomes.Methods Clinical data of 201 AIS patients aged 26-90 years old(y/o)treated by IVT with recombinant tissue plasminogen activation(rtPA)between January 2015 and February 2017 were retrospectively analyzed.The gender,age,body weight,onset to needle time(ONT),the modified rankin scale(mRS)scores before onset,baseline National Institutes of Health Stroke Scale(NIHSS)score,history of smoking,hypertension,hyperlipemia,atrial fibrillation,coronary artery disease,diabetes mellitus,congestive heart failure,baseline blood glucose,baseline systolic pressure,platelets counts,fibrinogen,and uric acid,hemorrhagic transformation(HT)rate,and 90-day m RS scores were documented and compared between patients≥80 y/o(n=31)and patients<80 y/o(n=170)with Chi-square tests,t test and Wilcoxon rank sum test.The baseline data and HT rate between patients≥80 y/o with favorable clinical outcomes(90-day m RS≤2,n=20)and those with unfavorable clinical outcomes(90-day m RS>2,n=11).Results No significant difference in demographic data,clinical baseline data,HT,and clinical outcomes was found between AIS patients≥80 y/o treated with IVT and younger patients.In AIS patients≥80 y/o,patients with 90-day unfavorable outcomes had no significant difference in demographic data,clinical baseline data,HT,other than higher median NIHSS scores(P=0.02)and higher incidence of symptomatic intracranial hemorrhage(P=0.036),compared with those with 90-day favorable outcomes.Conclusion Outcomes and risks of IVT within0~4 hours in AIS patients≥80 y/o are not significantly different with those in younger patients.Higher median NIHSS scores and higher incidence of symptomatic intracranial hemorrhage may be associated with worse clinical outcomes in AIS patients≥80 y/o treated with IVT.