Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis

BACKGROUND Acute ischemic stroke(AIS)retains a notable stance in global disease burden,with thrombolysis via recombinant tissue plasminogen activator(rtPA)serving as a viable management approach,albeit with variable outcomes and the potential for complications like hemorrhagic transformation(HT).The platelet-to-neutrophil ratio(P/NR)has been considered for its potential prognostic value in AIS,yet its capacity to predict outcomes following rtPA administration demands further exploration.AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients.METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed.The relationship between P/NR and clinical outcomes[early neurological deterioration(E-ND),HT,delayed ND(D-ND),and 3-mo outcomes]was scrutinized.RESULTS Notable variables,such as age,diabetes,and stroke history,exhibited statistical disparities when comparing patients with and without E-ND,HT,D-ND,and 3-mo outcomes.P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3%sensitivity and a 52.5%specificity for 90-d outcomes.P/NR prognostic accuracy was statistically significant for 90-d outcomes[area under the curve(AUC)=0.562],D-ND(AUC=0.584),and HT(AUC=0.607).CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes,HT,and D-ND in AIS patients post-rtPA administration,indicating its potential as a predictive tool for complications and prognoses.This infers that a diminished P/NR may serve as a novel prognostic indicator,assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.

The Effect of the Early Application of Tirofiban on Acute Ischemic Stroke (AIS) after Intravenous Thrombolysis with Urokinase

Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.

Application of Time-Tracking Platform in the Reperfusion Treatment of Patients with Acute Ischemic Stroke in Primary Hospitals

Objective To explore the application effect of time tracking platform in improving the reperfusion treatment of patients with acute ischemic stroke in primary hospitals. Methods and Results Patients with acute ischemic stroke who carried out emergency intravenous thrombolysis and arterial thrombectomy in our hospital in 2021, 2022 and 2023 were selected. The time tracking mode was implemented, and the patients were recorded at each time node of the hospital and the whole-process digital management was conducted. Compared the mean DNT (Door to Needle Time) of intravenous thrombolysis in emergency stroke patients in 2021, 2022 and 2023, the total number of hospital cases within 4.5 h of onset, the total number of thrombolysis cases within 4.5 h of onset, the number of intravenous thrombolysis in 60 minutes of acute ischemic stroke, and the number of thrombolysis cases. The results show that from 2021 to 2023 our emergency stroke patients with intravenous thrombolysis average DNT shortened year by year, to the hospital within 4.5 h after the onset of the difference is statistically significant (all P < 0.05) conclusion through the application of stroke time tracking platform, is beneficial to shorten the treatment time of each link, can effectively reduce the hospital time delay, improve the rate of thrombolysis, improve the reperfusion of stroke centers in primary hospitals.

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase:a meta-analysis

Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.

Efficacy and safety of argatroban in treatment of acute ischemic stroke:A meta-analysis

BACKGROUND Argatroban is a novel direct thrombin inhibitor that has been used for treatment of acute ischemic stroke(AIS).To our knowledge,no systematic analysis has assessed the efficacy and safety of argatroban for treatment of AIS.AIM To evaluate the efficacy and safety of argatroban for treatment of AIS.METHODS Cochrane Library,Medline,PubMed,and Web of Science were searched to retrieve all studies associated with argatroban and AIS.Effective rate,adverse events rate,and 95%confidence intervals were calculated and pooled using metaanalysis methodology.RESULTS We only found four randomized controlled studies,comprising 354 cases with 213 in the argatroban group and 141 in the control group.Great heterogeneity was found in the four studies(c2=11.44,I2=74%,P=0.01).Subgroup analysis could not be performed because of the absence of detailed data.The two most recent studies showed acceptable heterogeneity(c2=1.56,I2=36%,P=0.21).Our analysis showed that argatroban was not more effective than the control therapy in the acute phase of ischemic stroke(Z=0.01,P=0.99).Argatroban did not increase the risk of bleeding compared with the control group(c2=0.37,I2=0%,P=0.54,Z=0.80,P=0.42).CONCLUSION Patients with AIS might not benefit from argatroban and combination therapy with argatroban does not increase bleeding tendency.

Successful recanalization with multimodality endovascular interventional therapy in acute ischemic stroke

Stroke is an important cause of death and disability in adults. However, effective treatments for patients with acute ischemic stroke are limited. Intravenous recombinant tissue plasminogen activator(iv rtPA) within 4.5 h after onset has been approved as a standard treatment for patients with acute ischemic stroke. However, due to time constraints, less than one percent of acute ischemic stroke patients in Thailand are able to obtain iv rtPA. Although endovascular interventional therapy has not yet been approved as standard treatment in acute ischemic stroke, it is the one of the potentially effective treatment options. There are several reliable methods of endovascular therapy for acute ischemic stroke patients. Endovascular interventional therapy has rarely been done in Thailand. We report seven patients with successful recanalization after endovascular treatment in acute large vessel stroke from a single stroke center in Thailand. Patient screening and selection with multimodal imaging protocol and multimodality methods of endovascular interventional therapy are described.

Acute ischemic Stroke combined with Stanford type A aortic dissection:A case report and literature review

BACKGROUND Acute aortic dissection(AAD)is a high mortality disease that can lead to acute ischemic strokes(AIS).Some of the patients with AAD combined with AIS initially present with neurological symptoms,which can easily lead to missed or delayed AAD diagnosis.This is attributed to the lack of physician awareness or the urgency of patient thrombolysis.Intravenous administration of thrombolytic therapy(IVT)for AAD is associated with poor prognostic outcomes.We report a patient with AIS combined with AAD who developed a massive cerebral infarction after receiving IVT for a missed AAD diagnosis.CASE SUMMARY A 49-year-old man was admitted to a local hospital with an acute onset of leftsided limb weakness accompanied by slurred speech.The patient had a history of hypertension that was not regularly treated with medication.Physical examination revealed incomplete mixed aphasia and left limb hemiparesis.Cranial computed tomography(CT)scan showed bilateral basal ganglia and lateral ventricular paraventricular infarct lesions.The patient was diagnosed with AIS and was administered with IVT.After IVT,patient’s muscle strength and consciousness deteriorated.From the local hospital,he was referred to our hospital for further treatment.Emergency head and neck CT angiography(CTA)scans were performed.Results showed multiple cerebral infarctions,and aortic dissection in the ascending aorta,innominate artery,as well as in the right common carotid artery.Then,the CTA of thoracoabdominal aorta was performed,which revealed a Stanford type A aortic dissection and aortic dissection extending from the aortic root to the left external iliac artery.Laceration was located in the lesser curvature of the aortic arch.AAD complicated with AIS was considered,and the patient was immediately subjected to cardiovascular surgery for treatment.The next day,the patient underwent aortic arch and ascending aortic replacement and aortic valvuloplasty.CONCLUSION Clinical manifestations for AAD combined with AIS are diverse.Some patients may not exhibit typical chest or back pains.Therefore,patients should be carefully evaluated to exclude AAD before administering IVT in order to avoid adverse consequences.

Management of Acute Ischemic Stroke in a Patient with a Past History of Intracranial Hemorrhage

Intravenous thrombolysis remains the gold standard in the management of acute ischemic stroke if the patient presents within the window period. Endovascular thrombectomy is another line of therapy in selected cases. Nonetheless, one of the most devastating complications of IV thrombolysis is intracranial hemorrhage (ICH);in such cases, the previous history of ICH is considered a potential contraindication to thrombolysis. Evidence regarding the safety of thrombolysis administration in patients with a previous history of ICH is scarce. We encountered a patient with acute ischemic stroke with a past history of hypertensive ICH. A 59-year-old female, presented with complete right-sided body weakness, global aphasia and gaze preference. A computed tomography (CT) brain perfusion scan revealed a mismatch suggestive of left middle cerebral artery (MCA) ischemic stroke. The patient received intravenous thrombolysis and showed significant clinical improvement with no subsequent complications or ICH. In reporting this case, we aim to provide evidence supporting the safety of thrombolytic therapy in selected cases with a previous history of ICH when no alternative line of management is available.

Clinical characteristics and treatment strategies of acute ischemic stroke with internal carotid artery occlusion: a case report

Acute ischemic stroke has the characteristics of high disability,lethality and recurrence rate,which seriously threatens the health of middle-aged and elderly people.This article describes the acute ischemic stroke with internal carotid artery occlusion as the main clinical feature and discusses its treatment strategy.Treatment remedies:clinical diagnosis was carried out based on the present medical history,physical examination and craniocerebral CT(computed tomography).Neurological function was improved by intravenous thrombolysis,cerebrovascular angiography was used to clarify cerebrovascular occlusion,cerebral blood supply was identified by CT perfusion,and neurological function recovery was followed up.After intravenous thrombolysis,the patient’s consciousness turned clear and the right limb muscle strength recovery was not obvious,but the patient did not receive bridging therapy.Cerebral angiography showed about 90%stenosis at the beginning of the left internal carotid artery,and the blood flow terminated at the C7 segment.Cerebral CT perfusion imaging showed decreased perfusion in the left cerebral hemisphere,but the patient did not receive carotid endarterectomy and vascular bypass treatment.Post treatment evaluating:follow-up showed that NIHSS(National Institute of Health stroke scale)score was significantly decreased and limb function was significantly restored.Conclusion:early intravenous thrombolytic therapy can help reduce the area of ischemic penumbra and improve long-term prognosis.Severe vascular stenosis can stimulate vascular compensation,significantly reduce the range of ischemia when thrombus occurs,and effectively reduce the disability rate without bridging therapy.Whether vascular stenosis and occlusion are treated by vascular bypass,etc.,individualized plans should be made according to vascular compensation.

Do statins reduce the mortality rate in stroke patients treated with systemic thrombolysis in a 5-year single-center study?

The present study investigated the association between pre-treatment with a cholesterol-lowering drug(statin) or new setting hereon and the effect on the mortality rate in patients with acute ischemic stroke who received intravenous systemic thrombolysis. During a 5-year period(starting in October 2008), 542 consecutive stroke patients who received intravenous systemic thrombolysis with recombinant tissue plasminogen activator(rt-PA) at the Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany, were included. Patients were characterized according to statins. The primary endpoint was mortality;it was assessed twice: in hospital and 3 months after discharge. The secondary outcome was the rate of symptomatic intracerebral hemorrhage. Of the 542 stroke patients examined(mean age 72 ± 13 years;51% women, mean National Institutes of Health Stroke Scale(NIHSS) score 11), 138 patients(25.5%) had been pretreated with statin, while in 190 patients(35.1%) statin therapy was initiated during their stay in hospital, whereas 193(35.6%) never received statins. Patients pre-treated with statin were older and more frequently had previous illnesses(arterial hypertension, diabetes mellitus and previous cerebral infarctions), but were comparably similarly affected by the stroke(NIHSS 11 vs. 11;P = 0.76) compared to patients who were not on statin treatment at the time of cerebral infarction. Patients pretreated with statin did not differ in 3-month mortality from those newly treated to a statin(7.6% vs. 8%;P = 0.9). Interestingly, the group of patients pretreated with statin showed a lower rate of in hospital mortality(6.6% vs. 17.0;P = 0.005) and 3-month mortality(10.7% vs. 23.7%;P = 0.005) than the group of patients who had no statin treatment at all. The same effect was seen for patients newly adjusted to a statin during the hospital stay compared to patients who did not receive statins(3-month mortality: 7.1% vs. 23.7%;P < 0.001). With a good functional outcome(mRS ≤ 2), 60% of patients were discharged, the majority(69.6%;P < 0.001) of whom received a statin at discharge. The rate of symptomatic intracerebral hemorrhages in the course of cranial computed tomography was independent of whether the patients were pretreated with a statin or not(8.8% vs. 8.7%, P = 0.96). Pre-treatment with statin as well as new adjustment could reveal positive effect on prognosis of intravenous thrombolyzed stroke patients. Further investigations are required. The study was approved by the Ethic Committee of the University of Lübeck(approval No. 4-147).

F-stroke软件指导下急性缺血性脑卒中超时间窗静脉溶栓治疗的安全性和有效性分析

目的探讨发病时间4.5~9.0 h的急性缺血性脑卒中患者在基于脑计算机断层扫描灌注成像(CTP)的F-stroke软件指导下进行静脉溶栓治疗的安全性和有效性,并分析患者预后的影响因素。方法回顾性分析发病时间4.5~9.0 h的108例急性缺血性脑卒中患者的临床资料,完成脑CTP检查及F-stroke软件进行后期图像分析,将患者按是否静脉溶栓分为治疗组(51例)和对照组(57例)。治疗组给予静脉溶栓治疗,后续口服抗血小板聚集[溶栓后24 h无出血转化(HT)]、他汀药物,静脉滴注丁苯酞注射液、依达拉奉右坎醇治疗。对照组口服抗血小板聚集、他汀药物,静脉滴注丁苯酞注射液、依达拉奉右坎醇治疗。比较两组患者临床资料以及F-stroke软件分析结果[脑血流达峰时间>4 s、>6 s、>8 s、>10 s的低灌注区体积(V_(Tmax>4 s)、V_(Tmax>6 s)、V_(Tmax>8 s)、V_(Tmax>10 s))、脑血流量<30%的体积(V_(CBF<30%))、不匹配体积];比较两组不同时间美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分量表(mRS)评分、远期预后及卒中后24~36 h的HT发生率;分析急性缺血性脑卒中超时间窗静脉溶栓治疗预后的影响因素。结果治疗组F-stroke软件分析结果中的V_(Tmax>4 s)(157.43±137.18)ml大于对照组的(107.56±107.26)ml,差异具有统计学意义(P<0.05)。治疗组卒中后7 d NIHSS评分(4.04±5.18)分低于基线NIHSS评分(6.00±4.41)分,差异有统计学意义(P<0.05)。两组卒中后90 d mRS评分均低于本组入院时mRS评分,差异有统计学意义(P<0.05)。两组基线NIHSS评分、卒中后7 d NIHSS评分、入院时mRS评分、卒中后90 d mRS评分比较,差异无统计学意义(P>0.05)。治疗组远期预后良好率稍高于对照组,但差异无统计学意义(P>0.05)。两组卒中后24~36 h的HT发生率比较差异无统计学意义(P>0.05)。两组均未发生症状性颅内出血(SICH)。二元Logistic回归分析结果显示:入院时m RS评分是超时间窗静脉溶栓患者预后的影响因素(P<0.05)。得到模型公式:ln(p/1-p)=7.840-2.111×入院时mRS评分(其中p代表预后良好的几率,1-p代表预后不良的几率)。结论通过基于脑CTP的F-stroke软件的筛选,适当延长静脉溶栓时间窗(4.5~9.0 h)的溶栓治疗是安全的,也可能是有效的,值得进一步研究验证。

Intravenous thrombolysis for acute ischemic stroke with extended time window

Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for>4.5 h.Methods:We searched PubMed,Embase,Web of Science,Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT(IVT group)and placebo or usual care(control group[CG])in AIS patients with disease onset for>4.5 h.The outcomes of interest included the favorable functional outcome(defined as modified Rankin Scale[mRS]scores 0–1)at 90 days,the functional independence(defined as mRS scores 0–2)at 90 days,proportion of patients with symptomatic intracerebral hemorrhage(sICH)and death at 90 days.We assessed the risk of bias using the Cochrane tool.Pre-specified subgroup analyses were performed by age(70 years or>70 years),National Institute of Health Stroke Scale(NIHSS,10 or>10)and time window(4.5–9.0 h or>9.0 h).Results:Four trials involving 848 patients were eligible.The risk of bias of included trials was low.Patients in the IVT group were more likely to achieve favorable functional outcomes(45.8%vs.36.7%;OR 1.48,95%CI 1.12–1.96)and functional independence(63.8%vs.55.7%;OR 1.43,95%CI 1.08–1.90)at 90 days,but had higher risk of sICH(3.0%vs.0.5%;OR 5.28,95%CI 1.35–20.68)at 90 days than those in the CG.No significant difference in death at 90 days was found between the two groups(7.0%vs.4.1%;OR 1.80;95%CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days,although IVT may induce increased risk of sICH.Care of these patients should well balance the potential benefits and harms of IVT.

Factors associated with early neurological deterioration after intravenous thrombolysis with alteplase in patients with acute ischemic stroke

Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with in-

急性缺血性脑卒中病人静脉溶栓后出血转化与脑白质高信号的相关性

目的探究急性缺血性脑卒中(acute ischemic stroke,AIS)病人静脉溶栓治疗后出血转化与脑白质高信号(white matter hyperintensity,WMH)的相关性。方法回顾性分析137例AIS病例资料,均进行静脉溶栓治疗,根据是否发生出血转化分为出血组(53例)和未出血组(84例)。采用单因素与Logistic回归分析AIS病人治疗后出血转化的危险因素。结果两组病人年龄、美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分、高血压、发病到治疗时间、WMH程度比较,差异有统计学意义(P<0.05)。Logistic回归分析显示中重度WMH(OR=2.796,95%CI:1.450-5.391)是AIS病人治疗后出血转化的危险因素(P<0.05)。结论WMH是影响AIS病人溶栓治疗后出血转化的危险因素,中重度WMH病人发生出血转化的风险更高。

重组组织型纤维蛋白溶酶原激活剂静脉溶栓后不同时间加用替罗非班对急性缺血性脑卒中患者神经血管功能的影响

目的探讨重组组织型纤维蛋白溶酶原激活剂(rt-PA)静脉溶栓后不同时间加用替罗非班对急性缺血性脑卒中(AIS)患者神经血管功能的影响。方法选择2020年3月至2023年3月北京老年医院神经内科收治的120例AIS患者为研究对象,患者均经rt-PA静脉溶栓治疗。根据静脉溶栓治疗后加用替罗非班的时间将患者分为早期组(溶栓后6 h内,n=52)、中期组(溶栓后6~12 h,n=38)和晚期组(溶栓后12~24 h,n=30)。比较治疗前、治疗后3组患者神经功能[美国国立卫生院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分]、血管功能[血管性假血友病因子(vWF)、血管内皮细胞钙黏蛋白(VE-cadherin)、血栓调节蛋白(TM)]、炎症因子[高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、白细胞介素-1β(IL-1β)]水平,记录治疗期间不良事件发生率。结果治疗前,3组患者NIHSS、mRS评分比较差异无统计学意义(P>0.05);3组患者治疗后NIHSS、mRS评分显著低于治疗前(P<0.05);治疗后,早期组患者NIHSS、mRS评分显著低于中期组、晚期组,中期组患者NIHSS、mRS评分显著低于晚期组(P<0.05)。治疗前,3组患者vWF、VE-cadherin、TM水平比较差异无统计学意义(P>0.05);3组患者治疗后vWF、VE-cadherin、TM水平显著低于治疗前(P<0.05);治疗后,早期组患者vWF、VE-cadherin、TM水平显著低于中期组、晚期组(P<0.05);治疗后,晚期组患者vWF水平显著高于中期组(P<0.05),中期组与晚期组患者VE-cadherin、TM水平差比较异无统计学意义(P>0.05)。治疗前,3组患者hs-CRP、Hcy、IL-1β水平比较差异无统计学意义(P>0.05),3组患者治疗后hs-CRP、Hcy、IL-1β水平显著低于治疗前(P<0.05);治疗后,早期组患者hs-CRP、Hcy、IL-1β水平显著低于中期组和晚期组,中期组患者hs-CRP、Hcy、IL-1β水平显著低于晚期组(P<0.05)。治疗期间,3组患者症状性脑出血发生率比较差异无统计学意义(P>0.05);早期组患者再闭塞、心肺并发症发生率显著低于中期组、晚期组(P<0.05);中期组与晚期组患者再闭塞、心肺并发症发生率比较差异无统计学意义(P>0.05)。结论rt-PA静脉溶栓后不同时间加用替罗非班后均可促进AIS患者神经功能、血管功能恢复,同时可抑制炎症反应,其中早期加用替罗非班效果最佳。

急性缺血性脑卒中静脉溶栓预后不良预警模型构建

目的:对急性缺血性脑卒中(AIS)静脉溶栓的预后不良影响因素进行分析,构建其不良预警模型为其并发症防治提供依据。方法:收集256例AIS患者,4.5 h内均行静脉溶栓及用药后1 h内进行DWI检查,治疗3个月后按MRS评分结果分为82例预后不良组(>2分)和174例预后良好组(≤2分),采用Logistic回归分析预后不良影响因素,构建其预警模型及使用ROC曲线分析模型预测效能。结果:低DWI-ASPECTS和高NIHSS评分均是预后不良的危险因素(P=0.01)。ROC曲线显示,当NIHSS≥5分、DWI-ASPECTS<8分、NIHSS≥5分且DWI-ASPECTS<8分时,对静脉溶栓预后不良预测灵敏度、特异度、阳性率及阴性率分别为92%、47%、45%、92%,79%、80%、65%、89%,93%、73%、69%、94%,差别有统计学意义(P<0.01)。结论:AIS静脉溶栓预后不良危险因素是高基线NIHSS评分和低基线DWI-ASPECTS评分,联合构建其预后不良预警模型有助于防治静脉溶栓后并发症。

S-100β CysC和NF-κB对急性缺血性脑卒中患者静脉溶栓后出血转化的预测价值

目的 探讨急性缺血性脑卒中(AIS)外周血中S-100β、CysC和NF-κB水平对静脉溶栓后出血转化的影响及预测价值。方法 收集2019-03—2022-03接受溶栓治疗的AIS患者140例,根据溶栓后24 h是否发生出血转化(HT)将患者分为非HT组(n=112)和HT组(n=28)。比较2组一般临床资料,采用多因Logistic回归分析影响HT发生的危险因素,受试者工作特征(ROC)曲线评估S-100β、CysC和NF-κB预测HT发生的价值。结果 HT组与非HT组相比,患者年龄、发病至溶栓时间、房颤、TOAST分型、C反应蛋白、凝血酶原时间、S-100β、CysC、NF-κB、白质高信号和脑微出血等均有统计学差异(P<0.05)。Logistic多因素回归分析显示,房颤、S-100β、CysC和NF-κB为影响HT发生的危险因素。S-100β、CysC和NF-κB预测AIS患者静脉溶栓后出血转化的曲线下面积分别为0.915(0.902~0.923)、0.874(0.856~0.882)和0.789(0.771~0.796),均具有一定的预测价值。结论 S-100β、CysC和NF-κB为AIS患者静脉溶栓后HT发生的危险因素,对HT发生具有一定的预测价值。

阿替普酶静脉溶栓联合丁苯酞氯化钠注射液治疗急性缺血性脑卒中的效果

目的探讨阿替普酶(rt-PA)静脉溶栓联合丁苯酞氯化钠注射液治疗急性缺血性脑卒中(AIS)的效果。方法选择2022年1月至2023年1月吴川市人民医院收治的AIS患者100例作为研究对象,按随机数表法分为观察组和对照组各50例。对照组患者予以rt-PA静脉溶栓治疗,观察组患者在对照组基础上联合丁苯酞氯化钠注射液治疗,两组患者均持续治疗14 d。比较两组患者治疗14 d后的临床疗效,以及治疗前和治疗14 d后的美国国立卫生院卒中量表(NIHSS)评分、改良Rankin评分量表(mRS)评分、脑血流量(CBF)、脑血容量(CBV)和平均通过时间(MTT),比较两组患者出院后随访1年的复发率和再入院率。结果治疗后,观察组患者的临床疗效总有效率为92.00%,明显高于对照组的74.00%,差异有统计学意义(P<0.05);治疗14 d后,观察组患者的NIHSS评分为(10.34±2.27)分,明显低于对照组的(8.15±2.63)分,mRS评分为(72.64±11.40)分,明显高于对照组的(61.21±10.25)分,差异均有统计学意义(P<0.05);治疗14 d后,观察组患者的CBF、CBV分别为(21.43±2.18)mL/(10 g·min)、(2.19±0.23)mL/100 g,明显高于对照组的(19.75±1.85)mL/(10 g·min)、(2.01±0.27)mL/100 g,MTT为(6.34±0.68)s,明显短于对照组的(7.49±0.75)s,差异均有统计学意义(P<0.05);出院后随访1年,观察组患者的再入院率为2.04%,明显低于对照组的14.29%,差异有统计学意义(P<0.05)。结论rt-PA静脉溶栓联合丁苯酞氯化钠注射液治疗AIS患者的疗效显著,且有助于减少短期再入院率,值得临床推广应用。

Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator

Background Thrombolysis with recombinant tissue plasminogen activator （rt-PA） has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA. Methods One hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale （mRS） score, good outcome group： mRS score of 0-1; poor outcome group： mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression. Results Of the 101 patients studied, patients in good outcome group （n=55） were significantly younger than patients in poor outcome group （n=46, （62.82±14.25） vs. （68.81±9.85） years, P=0.029）. Good outcome group had fewer patients with diabetic history （9.09% vs. 28.26%, P=0.012）, fewer patients with leukoaraiosis （7.27% vs. 28.26%, P=-0.005） and presented with lower blood glucose level （（5.72±1.76） vs. （6.72±1.32） mmol/L, P=0.012）, lower systolic blood pressure level （（135.45±19.36） vs. （148.78±19.39） mmHg, P=0.003）, lower baseline NIHSS score （12.02±5.26 vs. 15.78±4.98, P=0.002） and shorter onset-to-treatment time （OTT） （（2.38±1.21） vs. （2.57±1.03） hours, P=0.044） than poor outcome group. Logistic regression analysis showed that absence of diabetic history （odds ratio （OR） 0.968 （95% CI 0.941-0.996））, absence of leukoaraiosis （OR 0.835 （95% C/0.712-0.980））, lower baseline NIHSS score （OR 0.885 （95% Cl 0.793- 0.989））, lower pre-thrombolysis systolic blood pressure （OR 0.962 （95% CI 0.929-0.997））, and lower blood glucose level （OR 0.699 （95% Cl 0.491-0.994）） before thrombolysis were significantly associated with better outcome. Conclusion Patients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolvsis have a better outcome.

依达拉奉右莰醇在高龄中重度急性缺血性脑卒中rt-PA静脉溶栓治疗中的应用时机

目的 探讨依达拉奉右莰醇在高龄中重度急性缺血性脑卒中(AIS)重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗中的应用时机。方法 选择rt-PA静脉溶栓救治的221例高龄中重度AIS患者,随机分为对照组70例、早期组75例、晚期组76例。对照组接受rt-PA静脉溶栓治疗,早期组在rt-PA静脉溶栓治疗启动后即刻给予依达拉奉右莰醇治疗,晚期组在rt-PA静脉溶栓24 h后给予依达拉奉右莰醇治疗。于治疗7 d时采用NIHSS评分评价神经功能改善情况,治疗90 d时采用mRS评分评价预后情况,比较三组短期疗效和长期疗效;观察24 h症状性颅内出血发生率、14 d颅外系统性并发症发生率和90 d病死率,比较三组治疗安全性。结果 三组7 d神经功能改善率、90 d预后良好率比较,早期组和晚期组均高于对照组,且早期组高于晚期组(P均<0.05)。三组24 h症状性颅内出血发生率、14 d颅外系统性并发症发生率比较,早期组低于晚期组和对照组(P均<0.05),晚期组与对照组比较差异无统计学意义(P>0.05)。三组90 d病死率比较,早期组和晚期组均低于对照组,且早期组低于晚期组(P均<0.05)。结论 高龄中重度AIS患者rt-PA静脉溶栓后即刻应用依达拉奉右莰醇可提高rt-PA静脉溶栓治疗的有效性和安全性,减少并发症的发生,改善患者预后。