rt-PA治疗合并缺血性脑白质病变的急性缺血性卒中患者的疗效评价

Evaluation the efficacy of rt-PA in the treatment of acute ischemic stroke complicated with ischemic white matter lesions

目的研究急性缺血性脑卒中(acute ischemic stroke,AIS)合并缺血性脑白质病变(white matter lesions,WML)患者行静脉溶栓治疗的有效性和安全性。方法收集天津市环湖医院神经内科四病区2018年10月-2019年7月期间收治的199例合并缺血性WML且发病在4.5 h内AIS患者,其中溶栓组患者99例,非溶栓组患者100例,进行回顾性分析。分析各组患者入院时、治疗后24 h及7 d的NIHSS评分,治疗后3 m的改良Rankin评分,分析溶栓后24 h不良事件发生情况(症状性颅内出血、非症状性颅内出血)和卒中相关病死率的差异性。结果溶栓组与对照组相比较,治疗24 h及7 d NIHSS评分水平明显下降(P<0.05)。3 m时远期预后溶栓组优于对照组(P<0.05)。溶栓后24 h颅内出血方面,溶栓组为7例(7.1%),非溶栓组为0,差异有统计学意义(P<0.05)。但两组之间的症状性脑出血、死亡率比较无统计学差异。结论合并缺血性脑白质病变的AIS患者行静脉溶栓治疗比非溶栓组预后明显要好,溶栓组比非溶栓组增加了一定的出血转化风险,但不会导致症状性颅内出血等不良反应的发生,也不会增加患者的死亡率,静脉溶栓治疗对于合并缺血性脑白质病变的AIS患者具有很高的安全性。

Objective To investigate the safety and efficacy of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke complicated with ischemic white matter lesions.Methods One hundred and ninety-nine patients with acute ischemic stroke complicated with ischemic white matter lesions were studied retrospectively.Ninety-nine patients received thrombolytic therapy(thrombolytic group)and 100 patients received routine antiplatelet aggregation therapy(control group).The NIHSS scores of patients in each group at admission,24 hours and 7 days after treatment were accessed.Modified Rankin score 3 months after treatment,adverse events(symptomatic intracranial hemorrhage,asymptomatic intracranial hemorrhage)and stroke-related deaths within 3 months were recorded.Results Compared with the control group,the levels of NIHSS in the thrombolytic group were significantly lower at 24 and 7 days(P<0.05).The long-term prognosis of thrombolytic group was better than that of control group at 3 months(P<0.05).Severn cases had of intracranial hemorrhage transformation after 24 h of thrombolysis(7.1%),in contrast,no patient had that in non-thrombolytic group(P<0.05).However,there was no significant difference in the incidence of symptomatic intracranial hemorrhage and mortality.Conclusion Merger of ischemic cerebral white matter lesions of AIS patients with venous thrombolysis treatment prognosis was obviously better.Thrombolysis group had increased bleeding risk,which will not lead to the occurrence of adverse reactions such as symptomatic intracranial bleeding,also does not increase mortality,in patients with venous thrombolysis treatment for merger of ischemic cerebral white matter lesions AIS patients have high security.