阿替普酶溶栓治疗后DWI阴性急性脑梗死患者的临床特点

Clinical Characteristics of Patients with DWI Negative Acute Cerebral Infarction After Alteplase Thrombolysis

目的分析阿替普酶(rt-PA)静脉溶栓治疗且发病2周内头部弥散加权成像(DWI)阴性急性脑梗死患者的临床特点.方法回顾性分析97例行rt-PA静脉溶栓的急性脑梗死患者临床资料,据头部DWI结果,分为DWI阴性组16例与DWI阳性组81例,比较两组临床资料、入院至静脉溶栓时间(DNT)、发病至静脉溶栓时间(OTT)、低密度脂蛋白(LDL)等.结果组间年龄、性别、1年内吸烟史、饮酒史、高血压病史、糖尿病病史、房颤病史、后循环梗死百分率、发病至DWI扫描时间、溶栓药物剂量、DNT、OTT等差异无统计学意义(P>0.05),具有可比性;DWI阴性组LDL、溶栓前NIHSS评分、溶栓24 h后NIHSS评分低于DWI阳性组(P=0.031、0.000、0.000),LDL水平低、溶栓前NIHSS评分低的患者易出现DWI阴性(OR=1.906、1.421,P<0.05).结论对LDL水平低、溶栓前NIHSS评分低的患者应警惕DWI阴性急性脑梗死.

Objective To analyze the clinical characteristics of patients with acute cerebral infarction treated with intravenous thrombolysis with alteplase(rt-PA)and negative head diffusion weighted imaging(DWI)within 2 weeks of onset.Methods The clinical data of 97 patients with acute cerebral infarction who underwent rt-PA intravenous thrombolysis were retrospectively analyzed.According to the results of head DWI at the time of admission,they were divided into 16 cases in the DWI negative group and 81 cases in the DWI positive group.The clinical data,door to needle time(DNT),onset to treatment time(OTT),low-density lipoprotein(LDL),etc.between the two groups were compared.Results The differences in age,gender,smoking history,drinking history,hypertension history,diabetes history,atrial fibrillation history,percentage of posterior circulation infarction,time from onset to DWI scan,thrombolytic drug dosage,DNT,and OTT were not significant(P>0.05)and were comparable;the DWI-negative group LDL,the NIHSS score before thrombolysis,and the NIHSS score 24 h after thrombolysis were lower than the DWI-positive group(P=0.031,0.000,0.000).Patients with low LDL levels and low NIHSS scores before thrombolysis are prone to negative DWI(OR=1.906,1.421,P<0.05).Conclusion Patients with low LDL levels and low NIHSS scores before thrombolysis should be alert to DWI-negative acute cerebral infarction.