青年卒中患者重组组织型纤溶酶原激活剂静脉溶栓临床疗效观察

Clinical efficacy of intravenous recombinant tissue-type plasminogen activator thrombolytic therapy in youth patients with cerebral infarction

目的分析急性缺血性脑卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗青年卒中患者预后的相关影响因素。方法回顾性研究徐州市中心医院2010年7月至2019年7月收治的102例青年脑卒中(年龄≤45岁)患者,入院后均接受rt-PA治疗,根据改良Rankin量表(mRS)评分将患者分为预后良好组(mRS<2分)和预后不良组(mRS≥2分),采用χ~2检验或t检验比较预后良好组和预后不好组之间的差异,采用Logistic回归分析进行预后因素的多因素分析。结果102例患者均完成90 d临床随访,其中预后良好组55例,占53.92%(55/102);预后不良组47例,占46.08%(47/102)。2组文化程度、溶栓前收缩压、血同型半胱氨酸水平、家族遗传史、血尿酸水平、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分比较差异均具有统计学意义(P均<0.05)。Logistic多因素分析显示,文化程度、溶栓前收缩压、血同型半胱氨酸水平、家族遗传史、血尿酸水平、溶栓前NIHSS评分是青年卒中患者预后的相关影响因素(P<0.05)。结论青年卒中患者预后不良与文化程度较低,收缩压、血同型半胱氨酸水平,血尿酸水平较高,有家族遗传,溶栓前NIHSS评分较高有关系,应当引起临床重视,及早采取针对性对策,最大限度改善青年卒中患者预后。

Objective To analyze the clinical efficacy of intravenous recombinant tissue-type plasminogen activator(rt-PA)thrombolytic therapy in stroke in young adults.Methods A retrospective study was performed on 102 young stroke patients(age≤45 years)admitted to Xuzhou Central Hospital from July 2010 to July 2019.All patients were treated with rt-PA after admission,and the Rankin Scale(mRS)was modified based on the 90-day clinical outcome and used to divide patients into either a good prognosis group(mRS score<2 points)or a poor prognosis group(mRS score≥2 points).The differences in variables were compared between the two groups using theχ~2 test or the t-test.Multivariate analysis was performed to identify the prognostic factors for young stroke patients.Results All the 102 patients completed the 90-day clinical follow-up,of whom 55 had a good prognosis,accounting for 53.92%(55/102),and 47 had a poor prognosis,accounting for 46.08%(47/102).Univariate analysis demonstrated that education level,diastolic blood pressure before thrombolysis,blood homocysteine(Hcy),family genetic history,blood uric acid,and pre-thrombotic National Insitute of Health stroke scale(NIHSS)score differed significantly between the two groups(all P<0.05).Multivariate Logistic analysis confirmed that education level,pre-thrombotic systolic blood pressure,Hcy,family genetic history,blood uric acid,and pre-thrombotic NIHSS scores were related to poor prognosis of young stroke patients(P<0.05).Conclusion The poor prognosis of young stroke patients is closely related to lower education level,higher systolic blood pressure,Hcy,higher uric acid,genetic family history,and higher NIHSS score before thrombolysis.These factors should be clinically targeted to improve the prognosis of young stroke patients.