阿替普酶静脉溶栓治疗缺血性脑卒中112例的预后影响因素分析

Analysis of prognostic factors in 112 cases of ischemic stroke treated with alteplase intravenous thrombolysis

目的探讨阿替普酶静脉溶栓治疗急性缺血性脑卒中病人90 d后预后的相关影响因素。方法纳入2016年1月至2019年1月在上海市第六人民医院金山分院诊断为急性缺血性脑卒中并进行静脉阿替普酶溶栓的病人,收集病人的基线资料,测定溶栓后90 d病人改良Rankin量表(modified Rankin scale,mRS)评分,将病人分为预后良好组(0~2分)与预后不良组(3~6分)。采用二元logistic回归分析不良预后的影响因素。结果共纳入病人112例。其中,男66例(58.93%),女46例(41.07%)。90 d随访显示,75例(66.96%)预后良好,37例(33.04%)预后不良。单因素分析显示,病人年龄、性别、糖尿病史、冠心病史、房颤史、合并卒中后肺炎、有颅内出血、DNT、溶栓前NIHSS评分与不良预后有关(P<0.1)。其中,预后不良组中有颅内出血患者占27%(10/37),远高于预后良好组的1.3%(1/75);预后不良组患者溶栓前NIHSS评分为18(14,22.5),明显高于预后良好组的7(5,13)。二元logistic回归分析显示,有颅内出血转化及较高的溶栓前NIHSS评分是溶栓后不良预后的独立危险因素(P<0.05)。结论有颅内出血转化及较高的溶栓前NIHSS评分与急性缺血性脑卒中静脉溶栓治疗后90 d预后不良密切相关,密切监测评估出血转化及准确记录溶栓前NIHSS评分对提供临床决策及指导预后有重要意义。

Objective To investigate the factors related to the poor prognosis of patients with acute ischemic stroke 90 days after in⁃travenous thrombolysis with alteplase.Methods Patients with acute ischemic stroke treated with recombinant tissue plasminogen acti⁃vator in the Department of Neurology,Jinshan Branch,Shanghai Sixth People's Hospital from January 2016 to January 2019 were en⁃rolled.Baseline data of the patients was collected,the modified Rankin Scale(mRS)score of patients 90 days after thrombolysis was measured,and the patients were assigned into a good prognosis group(0-2 points)and a poor prognosis group(3-6 points).Binary logis⁃tic regression was used to analyze the factors affecting the poor prognosis.Results A total of 112 patients were enrolled.Among them,66 were males(58.93%)and 46 were females(41.07%).The 90-day follow-up showed that 75 cases(66.96%)had a good prognosis and 37 cases(33.04%)had a poor prognosis.Univariate analysis showed that the patient's age,gender,history of diabetes,history of coro⁃nary heart disease,history of atrial fibrillation,post-stroke pneumonia,intracranial hemorrhage,DNT,and NIHSS score before throm⁃bolysis were related to poor prognosis(P<0.1).Among them,patients with intracranial hemorrhage accounted for 27%(10/37)in the poor prognosis group,which was much higher than 1.3%(1/75)in the good prognosis group;the NIHSS score of the patients in the poor prognosis group before thrombolysis was 18(14,22.5),significantly higher than 7(5,13)in the good prognosis group.Binary Logistic regression analysis showed that intracranial hemorrhage transformation and higher NIHSS score before thrombolysis were independent risk factors for poor prognosis after thrombolysis(P<0.05).Conclusion The transformation of intracranial hemorrhage and the higher NIHSS score before thrombolysis are closely related to the poor prognosis 90 days after intravenous thrombolysis for acute ischemic stroke.Close monitoring and evaluation of hemorrhage transformation and accurate recording of NIHSS score before thrombolysis can provide clinical decision-making And guiding the prognosis is of great significance.