Ischemic stroke is an important disease leading to death and disability for all human beings, and the key to its treatment lies in the early opening of obstructed vessels and restoration of perfusion to the local infa...Ischemic stroke is an important disease leading to death and disability for all human beings, and the key to its treatment lies in the early opening of obstructed vessels and restoration of perfusion to the local infarcted area. Intravenous thrombolysis with tissue plasminogen activator (tPA) is one of the effective therapies to achieve revascularization, but it faces strict indications with a narrow therapeutic time window, and significantly increases the incidence of hemorrhagic transformation, HT, after reperfusion of the infarcted foci, which greatly reduces the incidence of patients with ischemic stroke. which significantly increases the incidence of hemorrhagic transformation (HT) after reperfusion of the infarcted focus, greatly reducing patient utilization and clinical benefit. Since the mechanism of HT has not been fully elucidated, and the related molecular mechanisms are complex and interactive, there is no specific and effective therapy to avoid the occurrence of HT. In this article, we focus on the research progress on the mechanism of HT after tPA intravenous thrombolysis in ischemic stroke patients from the aspects of vascular integrity disruption, oxidative stress, and neuroinflammatory response and the corresponding therapeutic strategies, in order to improve the safety and prognosis of tPA intravenous thrombolysis in the clinic.展开更多
文摘Ischemic stroke is an important disease leading to death and disability for all human beings, and the key to its treatment lies in the early opening of obstructed vessels and restoration of perfusion to the local infarcted area. Intravenous thrombolysis with tissue plasminogen activator (tPA) is one of the effective therapies to achieve revascularization, but it faces strict indications with a narrow therapeutic time window, and significantly increases the incidence of hemorrhagic transformation, HT, after reperfusion of the infarcted foci, which greatly reduces the incidence of patients with ischemic stroke. which significantly increases the incidence of hemorrhagic transformation (HT) after reperfusion of the infarcted focus, greatly reducing patient utilization and clinical benefit. Since the mechanism of HT has not been fully elucidated, and the related molecular mechanisms are complex and interactive, there is no specific and effective therapy to avoid the occurrence of HT. In this article, we focus on the research progress on the mechanism of HT after tPA intravenous thrombolysis in ischemic stroke patients from the aspects of vascular integrity disruption, oxidative stress, and neuroinflammatory response and the corresponding therapeutic strategies, in order to improve the safety and prognosis of tPA intravenous thrombolysis in the clinic.
文摘目的:探究急性缺血性脑卒中(Acute ischemic stroke,AIS)患者入院时血清25羟维生素D_(3)(25-hydroxyl vitamin D3,25-(OH)D3)、镁离子(Magnesium,Mg^(2+))、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)水平的变化及预测近期结局的价值。方法:回顾性分析2021年1月至2023年11月本院收治的67例AIS患者及同期60例健康者的临床资料,比较两组血清25(OH)D3、Mg^(2+)、LDL-C水平的差异;应用美国国立卫生院卒中量表将AIS患者按病情严重程度分为轻度组(n=25)、中度组(n=22)和重度组(n=20),比较三组上述指标的差异;同时出院后随访3 m以改良Rankin评分评价AIS近期结局,比较不同预后组上述指标的差异并应用受试者工作特征(Receiver operating characteristic,ROC)曲线和曲线下面积(Area under the curve,AUC)分析其预测价值。结果:AIS组血清25(OH)D3、Mg^(2+)水平低于健康组,LDL-C水平高于对照组(P<0.05);重度组AIS患者血清25(OH)D3、Mg^(2+)水平均低于中度组及轻度组,LDL-C水平高于中度组及轻度组(P<0.05);随访3 m将AIS患者分为预后不良组(n=29)和预后良好组(n=38),预后不良组血清25(OH)D3、Mg^(2+)水平低于预后良好组,LDL-C水平高于预后良好组(P<0.05);ROC分析显示,血清25(OH)D3、Mg^(2+)、LDL-C单独和联合检查的AUC分别为0.784、0.806、0.884、1.000,对AIS患者近期结局的预测均具有一定的价值(P<0.05),对不良预后的预测均具有一定的价值(P<0.05)。结论:AIS患者多表现血清25(OH)D3、Mg^(2+)水平下降和LDL-C水平升高,对于近期结局的预测具有一定的价值。
