DWI-FLAIR部分匹配的醒后缺血性脑卒中静脉溶栓治疗的安全性与有效性

Safety and Efficacy of DWI-FLAIR Partially Matched Intravenous Thrombolytic Therapy for Wake-up Ischemic Stroke.

目的探讨扩散加权像(diffusion-weighted imaging,DWI)-液体衰减反转恢复序列(fluid-attenuated inversion recovery imaging,FLAIR)部分匹配时指导醒后缺血性脑卒中(wake-up ischemic stroke,WUIS)患者静脉溶栓治疗的安全性与有效性。方法收集2019年1月~2021年12月青岛大学医学院附属烟台毓璜顶医院收治的通过DWI-FLAIR评估后应用重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓的106例WUIS患者作为研究对象,根据头颅磁共振结果分为DWI-FLAIR部分匹配组(n=56)和DWI-FLAIR不匹配组(n=50),比较两组静脉溶栓治疗后颅内出血转化情况及溶栓后效果。结果DWI-FLAIR部分匹配组与DWI-FLAIR不匹配组颅内出血转化风险比较,差异无统计学意义(0 vs 4%,P=0.220);DWI-FLAIR部分匹配组在短期神经功能改善方面(NIHSS评分下降≥2分)略逊于DWI-FLAIR不匹配组,差异有统计学意义(64.3%vs 82.0%,χ2=4.171,P=0.041);两组在短期预后良好方面(出院时mRS评分0~2分),差异无统计学意义(85.7%vs 80.0%,χ2=0.612,P=0.434)。结论DWI-FLAIR部分匹配的WUIS患者行静脉溶栓治疗,其安全性较高,有效性略低于DWI-FLAIR不匹配的患者。

Objective To explore the safety and efficacy of intravenous thrombolytic therapy in patients with wake-up ischemic stroke(WUIS)when partially matched with diffusion-weighted MR imaging(DWI)-fluid-attenuated inversion recovery imaging(FLAIR).Methods A total of 106 WUIS patients who were admitted to Yantai Yuhuangding Hospital Affiliated to Qingdao University School of Medicine from January 2019 to December 2021 were selected as the research subjects.After DWI-FLAIR assessment,all patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rtPA).According to the results of brain MRI,they were divided into DWI-FLAIR partially matched group(n=56)and DWI-FLAIR mismatched group(n=50).The transformation of intracranial hemorrhage and the effect after thrombolysis were compared between the two groups.Results There was no significant difference in the risk of intracranial hemorrhage transformation between DWI-FLAIR partially matched group and DWI-FLAIR mismatched group(0 vs 4%,P=0.220);the DWI-FLAIR partially matched group showed improvement in short-term neurological function(NIHSS score decreased by≥2 points)was slightly inferior to the DWI-FLAIR mismatch group,and the difference was statistically significant(64.3%vs 82.0%,χ2=4.171,P=0.041);the short-term prognosis of the two groups was good(MRS score 0-2 at discharge),the difference was not statistically significant(85.7%vs 80.0%,χ2=0.612,P=0.434).Conclusion Intravenous thrombolysis in WUIS patients with DWI-FLAIR partial matching has higher safety and slightly less effective than that in patients with DWI-FLAIR mismatch.