轻型缺血性卒中患者静脉溶栓后转归

Outcomes of patients with minor ischemic stroke after intravenous thrombolysis

目的探讨轻型缺血性卒中患者静脉溶栓后转归及其影响因素。方法回顾性纳入2012年7月至2019年1月南京医科大学附属南京医院卒中数据库中接受静脉溶栓的轻型缺血性卒中患者,记录人口统计学、基线临床特征、治疗方法以及是否发生出血性转化和有症状颅内出血(symptomatic intracranial hemorrhage,sICH)。在发病后90 d时采用改良Rankin量表进行转归评价,0~1分定义为转归良好。应用多变量logistic回归分析确定转归的独立影响因素。结果共纳入295例患者,222例(75.3%)转归良好,73例(24.7%)转归不良。两组年龄(P=0.049)、空腹血糖(P=0.001)以及高血压(P=0.040)、卒中病因学分型(P=0.049)、抗血小板治疗方案(P=0.011)以及出血性转化(P=0.003)和sICH(P=0.001)差异有统计学意义(P均<0.1)。多变量logistic回归分析显示,年龄[优势比(odds ratio,OR)1.035,95%可信区间(confidence interval,CI)1.005~1.066;P=0.023]、空腹血糖(OR 1.203,95%CI 1.063~1.361;P=0.003)以及sICH(OR 20.126,95%CI 1.291~313.672;P=0.032)是转归不良的独立危险因素;与双药抗血小板治疗相比,单药抗血小板治疗患者转归不良风险增高2.5倍(OR 2.509,95%CI 1.280~4.917;P=0.007)。结论年龄、空腹血糖及sICH是轻型缺血性卒中患者静脉溶栓后转归不良的独立危险因素,而静脉溶栓后进行双药抗血小板治疗或许可进一步改善患者转归。

Objective To investigate the outcomes of patients with minor ischemic stroke after intravenous thrombolysis and its influencing factors.Methods Patients with minor ischemic stroke treated with intravenous thrombolysis in the Stroke Database,Nanjing First Hospital from July 2012 to January 2019 were enrolled retrospectively.Their demographics,baseline clinical characteristics,treatment methods,and whether the occurrence of hemorrhagic transformation and symptomatic intracranial hemorrhage(sICH)were documented.The modified Rankin Scale was used to evaluate the outcomes at 90 d after onset,and 0 to 1 was defined as good outcome.Multivariate logistic regression analysis was used to identify the independent influencing factors of outcomes.Results A total of 295 patients were included,222(75.3%)had a good outcome and 73(24.7%)had a poor outcome.There were significant differences in age(P=0.049),fasting blood glucose(P=0.001),as well as the proportions of hypertension(P=0.040),classification of stroke etiology(P=0.049),antiplatelet treatment options(P=0.011),hemorrhagic transformation(P=0.003)and sICH(P=0.001)between the two groups.Multivariate logistic regression analysis showed that age(odds ratio[OR]1.035,95%confidence interval[CI]1.005-1.066;P=0.023),fasting blood glucose(OR 1.203,95%CI 1.063-1.361;P=0.003)and sICH(OR 20.126,95%CI 1.291-313.672;P=0.032)were the independent risk factors for poor outcomes.Compared with the dual antiplatelet therapy,the risk of adverse outcome was 2.5 times higher in patients treated with single antiplatelet agent(OR 2.509,95%CI 1.280-4.917;P=0.007).Conclusions Age,fasting blood glucose and sICH were the independent risk factors for poor outcomes after intravenous thrombolysis in patients with minor ischemic stroke,and dual antiplatelet therapy after intravenous thrombolysis might further improve the outcomes of patients.