阿替普酶静脉溶栓治疗急性缺血性脑卒中的早期疗效及预后不佳驱动因素分析

Analysis of Driving Factors for Early Efficacy and Poor Prognosis of Alteplase Intravenous Thrombolytic Therapy in Acute Cerebral Ischemic Stroke

目的调查急性缺血性脑卒中(cerebral ischemic stroke,CIS)接受阿替普酶(alteplase,rt-PA)静脉溶栓治疗的早期疗效及预后不佳驱动因素。方法选取2020年9月—2023年5月南京市栖霞区医院收治的168例CIS患者进行回顾性研究,CIS患者均接受rt-PA溶栓治疗,根据其治疗后90 d预后情况纳入良好组(n=89)、不良组(n=79)。比较两组临床资料,调查早期疗效,并分析CIS患者接受rt-PA治疗后预后不佳的驱动因素。结果经多因素Logistic回归模型显示,高龄、发病至溶栓时间长、溶栓前美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、血糖水平、C反应蛋白(C-reactive protein,CRP)水平、合并高血压均为影响rt-PA静脉溶栓治疗CIS预后不佳的独立危险因素(OR=1.062、1.012、1.093、1.076、1.097、2.392,P<0.05)。结论高龄、发病至溶栓时间长、溶栓前NIHSS评分、高血糖水平、高CRP水平、合并高血压均为影响rt-PA静脉溶栓治疗CIS预后不佳的独立危险因素,因此在对CIS患者进行rt-PA静脉溶栓治疗时,医师可针对以上各个因素进行专业的处理,以改善预后质量。

Objective To investigate the early efficacy and the driving factors of poor prognosis in acute cerebral ischemic stroke(CIS)treated with alteplase(rt-PA)intravenous thrombolytic therapy.Methods A total of 168 CIS patients admitted to Nanjing Qixia District Hospital from September 2020 to May 2023 were selected for retrospective study.CIS patients received rt-PA thrombolytic therapy,and were divided into good group(n=89)and poor group(n=79)according to their prognosis at 90 days after treatment.The clinical data of the two groups were compared,the early efficacy was investigated,and the driving factors of poor prognosis in CIS patients treated with rt-PA were analyzed.Results Multivariate Logistic regression model showed that advanced age,long time from onset to thrombolysis,National Institute of Health stroke scale(NIHSS)score before thrombolysis,blood glucose level,C-reactive protein(CRP)level and hypertension were independent risk factors affecting the poor prognosis of CIS patients treated with rt-PA intravenous thrombolysis(OR=1.062,1.012,1.093,1.076,1.097,2.392,P<0.05).Conclusion Advanced age,long duration from onset to thrombolysis,pre-thrombolysis NIHSS score,high blood glucose level,high CRP level,and combined hypertension are all independent risk factors for poor prognosis of CIS after intravenous thrombolytic therapy with rt-PA.Therefore,physicians can conduct professional treatment for these factors when performing intravenous thrombolytic therapy with rt-PA for CIS patients to improve the quality of prognosis.