阿替普酶治疗急性缺血性脑卒中患者预后的影响因素

The influencing factors on the prognosis of patients with acute ischemic stroke treated by rt-PA

目的探讨急性缺血性脑卒中(AIS)患者应用阿替普酶(rt-PA)溶栓后预后的影响因素。方法回顾性分析2016年12月至2020年12月收治的执行rt-PA溶栓的AIS患者186例,溶栓90 d后应用改良Rankin量表(mRS)分为预后良好组和预后不良组,比较2组患者基本资料及血清学指标,采用Logistic回归分析预后不良的危险因素并采用受试者工作特征(ROC)曲线对有价值的指标进行有效性评价。结果治疗24 h后神经功能缺损评分(NIHSS)显著降低(P<0.05),随访至治疗后90 d,预后良好119例(64.0%),预后不良67例(36.0%),发生出血性转化14例(7.5%),死亡7例(3.8%)。多因素Logistic回归分析显示高龄(P=0.021)、长发病至溶栓时间(P=0.015)、高基线NIHSS评分(P=0.032)、高随机血糖水平(P<0.01)是预后不良的独立危险因素(P均<0.05)。ROC曲线分析显示四项联合指标预测预后不良的ROC曲线下面积明显大于单项指标预测面积(P<0.01),且联合指标的敏感度是86.7%,特异度是82.3%。结论年龄、发病至溶栓时间、基线NIHSS评分、空腹血糖水平可提示AIS患者静脉溶栓预后,四项联合可提高预测的敏感度和特异度,具有较高的临床价值。

Objective To investigate the influencing factors on the prognosis of patients with acute ischemic stroke(AIS)treated by recombinant tissue-type plasminogen activator(rt-PA).Methods The clinical dara about 186 patients with AIS who were treated by rt-PA thrombolysis in our hospital from December 2016 to December 2020 were retrospectively analyzed.According to the modified Rankin scale score 90 days after thrombolysis,the patients were divided into good prognosis group and poor prognosis group.The general demographic data,clinical data were observed and compared between the two groups.Multivariate Logistic regression analysis was performed to identify the independent risk factors for poor prognosis.The receiver operator characteristic(ROC)curve was used to evaluate the effectiveness of the valued indexes in predicting the prognosis of patients.Results After 24-hours treatment,the neurological function scores(National Institute of Health Stroke Scale NIHSS)were significantly decreased(P<0.05).After 90-day follow up,119 patients(64.0%)had good prognosis,and 67 patients(36.0%)had poor prognosis,and 14 patients(7.5%)developed hemorrhage transformation(HT)and 7 died(3.8%).The multivariate Logistic regression analysis showed that advanced age,long thrombolysis time,high NIHSS scores and high random blood glucose levels were the independent risk factors for the poor prognosis of patients with AIS after intravenous thrombolysis(P<0.05).The ROC curve analysis showed that the area in the ROC curve of the combined detection of the four indexes was significantly larger than that by simple index detection and the sensitivity and the specificity of combined detection of the four indexes were 86.7%and 82.3%,respectively.Conclusion The age,thrombolysis time,the baseline NIHSS score and random blood glucose levels are the indexes in predicting the prognosis of patients with acute AIS after intravenous thrombolysis treatment,and the combined detection of the four indexes can improve the sensetivity and specificity,therefore,it is of higher clinical application value.