急性轻型缺血性卒中rt-PA静脉溶栓预后影响因素研究

Study on the prognosis in patients with acute minor ischemic stroke after intravenous thrombolysis with alteplase

目的观察急性轻型缺血性卒中患者重组人组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗的预后,并探讨影响其预后的因素。方法回顾性分析接受rt-PA静脉溶栓治疗的76例急性轻型缺血性卒中患者的临床资料、病因分型及影像学资料,按治疗后第90天改良Rankin量表评分分为预后良好组(0~1分)及预后不良组(2~6分),采用多因素Logistic回归模型分析影响其溶栓预后的因素。结果治疗后预后良好组50例(65.79%),预后不良患者26例(34.21%),基线《美国国立卫生研究院卒中量表(NIHSS)》评分(OR=1.84,95%CI 1.12~3.01,P<0.05)、《Essen卒中风险评分量表(ESRS)》评分(OR=1.98,95%CI 1.10~3.54,P<0.05)、内囊区新发梗死(OR=5.69,95%CI 1.06~30.57,P<0.05)与急性轻型缺血性卒中静脉溶栓治疗后3个月功能良好预后独立相关。结论基线NIHSS评分、ESRS评分、大动脉病变、内囊区梗死是影响急性轻型缺血性卒中rt-PA静脉溶栓预后的独立因素。

Objective To observe the prognosis in patients with acute minor ischemic stroke after intravenous thrombolysis with alteplase,and to investigate the factors for the prognosis.Methods The clinical data,etiology and imaging information of 76 patients with acute minor ischemic stroke who received rt-PA intravenous thrombolysis were collected.According to the modified Rankin scale score on the 90th day after treatment,the patients were divided into good outcome(0~1 points)and poor outcome(2~6 points).Logistic regression analysis was used to evaluate the indexes in predicting the outcome of patients.Results After treatment,50 patients(65.79%)had good outcomes,26 patients(34.21%)had poor prognosis,NIHSS score before thrombolysis(OR=1.84,95%CI 1.122~3.014,P<0.05),ESRS score(OR=1.98,95%CI 1.10~3.54,P<0.05),large atherosclerosis(OR=6.05,95%CI 1.38~26.64,P<0.05),inner capsule infarction(OR=5.69,95%CI 1.06~30.57,P<0.05)was independently associated with good prognosis at three months after intravenous thrombolytic therapy.Conclusion The NIHSS score before thrombolysis,ESRS score,large atherosclerosis,inner capsule infarction are independent factors influencing the prognosis of rt-PA intravenous thrombolysis in acute ischemic stroke.