Effects of butyphthalide + rt-PA intravenous thrombolysis on the DWI characteristics, coagulation function and neurological function in patients with acute cerebral infarction

Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.

Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.

Anticoagulation effect of low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis for acute cerebral infarction

BACKGROUND： Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE： To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN： Observation experiment. SETTING： Department of Neurology, the 306 Hospital of Chinese PLA. PARTICIPANTS： Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients, 11 male and 4 female, were aged 46- 79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease （1995） and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS： On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis, skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4 - 8 IU/kg per hour was intravenously administrated for anticoagulation for 7 - 10 days successively. MAIN OUTCOME MEASURES： Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients （1995）. Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS： Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time： Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis （t =3.45, P 〈 0.01）. Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis, and neurologic deficits were increased, but no significant difference was found （P 〉 0.05）. Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis （t =4.769, P 〈 0.01）. ②Therapeutic effect and modified Rankin scale results： 14 days after thrombolysis, 4 patients were basically cured, 7 significantly improved, 2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis, according to modified Rankin Scale, score was 0 to 2 in 12 patients （80%）, 3 to 4 in 2 patients （13.3%） and 6 in 1 patient （6.7%）. Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION： Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.

Clinical study about mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction

Objective: To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction. Methods: A total of 176 patients with acute cerebral infarction who were treated in our hospital between September 2015 and February 2017 were reviewed and divided into the routine group (n=100 cases, receiving routine intravenous thrombolysis therapy) and the mild hypothermia group (n=76, receiving mild hypothermia + intravenous thrombolysis therapy), and the treatment lasted for 1 week. The differences in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters were compared between the two groups before treatment and after 1 week of treatment. Results: Before treatment, there was no statistically significant difference in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters between the two groups. After 1 week of treatment, serum nerve injury indexes H-FABP, NT-proBNP, NSE and S100B levels of mild hypothermia group were lower than those of routine group;inflammatory mediators sICAM-1, IL-8, IL-13 and IL-18 levels were lower than those of routine group;neurotransmitter Glu level was lower than that of routine group whereas GABA level was higher than that of routine group. Conclusion: mild hypothermia + intravenous thrombolysis therapy can effectively reduce the nerve injury and systemic inflammatory response, and optimize the neurotransmitter distribution in patients with acute cerebral infarction.

Evaluation of serological indicators of intravenous thrombolysis bridge stent combined with aspiration embolectomy for intracranial macrovascular infarction

Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.

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.

不同剂量rt-PA桥接治疗急性大血管闭塞性缺血性脑卒中的Meta分析

目的系统评价不同剂量重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓桥接机械取栓治疗急性大血管闭塞性缺血性脑卒中(AIS-LVO)的临床效果和安全性。方法采用主题词和自由词组合检索方式,通过计算机检索中国知网、万方、维普、Pubmed、SpringerLink、Web of Science,收集AIS-LVO患者分别采用标准剂量和低剂量rt-PA静脉溶栓桥接机械取栓的队列研究及随机对照研究,检索时限均为建库至2023年2月。提取相关数据并采用RevMan5.4软件进行Meta分析。结果共纳入5篇文献,共314例患者,其中标准剂量组142例,低剂量组172例。Meta分析结果显示,低剂量组与标准剂量组治疗后症状性脑出血率比较,差异有统计学意义(P<0.05);而两组90 d病死率、72 h美国国立卫生研究院卒中量表评分好转率、脑梗死溶栓(TICI)分级好转率及90 d改良Rankin量表评分好转率比较,差异无统计学意义(P>0.05)。结论在rt-PA静脉溶栓桥接机械取栓治疗后sICH率方面低剂量rt-PA优于标准剂量;在rt-PA静脉溶栓桥接机械取栓治疗后近期及远期神经功能变化、TICI分级好转率、治疗后90 d病死率方面,低剂量rt-PA不劣于标准剂量。

Evaluation of vascular recanalization rate and nerve injury of mechanical thrombectomy combined with rt-PA thrombolysis in treatment of acute cerebral infarction

Objective:To investigate the vascular recanalization rate of mechanical thrombectomy combined with recombinant tissue-type plasminogen activator (rt-PA) thrombolysis in the treatment of acute cerebral infarction and the effect on the nerve injury in patients.Methods:A total of 90 patients with acute cerebral infarction who were treated in our hospital between January 2016 and January 2019 were retrospectively analyzed and divided into the control group (n=46) receiving rt-PA thrombolysis and the observation group (n=44) receiving mechanical thrombectomy combined with rt-PA thrombolysis. The differences in vascular recanalization rate 24 h after treatment as well as serum levels of inflammatory mediators [interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-17 (IL-17) and hypersensitive C-reactive protein (hs-CRP)], nerve injury markers [brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE) and S100B protein (S100B)] and neurotransmitters [glutamate (Glu) and 5-hydroxytryptamine (5-HT)] before and after treatment were compared between the two groups of patients.Results: 24 h after treatment, the vascular recanalization rate of the observation group was higher than that of the control group (P<0.05). 24 h after treatment and 1 week after treatment, serum IL-1, IL-6, IL-7, IL-17 and hs-CRP levels in the observation group were lower than those in the control group;BDNF level was higher than that in the control group, while NSE and S100B levels were lower than those in the control group;Glu and 5-HT levels were lower than those in the control group (P<0.05). Conclusions: Mechanical thrombectomy combined with rt-PA thrombolysis can increase the early postoperative vascular recanalization rate in patients with acute cerebral infarction, and it also plays an active role in alleviating nerve injury.

老年急性脑梗死rt-PA静脉溶栓治疗后益处发现水平的影响因素分析

目的 分析老年急性脑梗死(ACI)患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后益处发现水平的影响因素。方法 选取2021年1月至2024年1月医院收治的107例接受rt-PA静脉溶栓治疗的老年ACI患者进行横断面研究。记录研究所需资料,采用多元线性回归分析老年ACI患者rt-PA静脉溶栓治疗后益处发现的影响因素。结果 107例患者治疗后益处发现量表总分为(44.54±6.97)分,各条目均分为(2.34±0.37)分。单因素分析显示,不同年龄、文化程度、家庭人均月收入、心理弹性、社会支持的老年ACI患者rt-PA静脉溶栓治疗后益处发现量表评分比较(P<0.05)。多元线性回归分析显示,年龄、文化程度、家庭人均月收入、心理弹性、社会支持均为老年ACI患者rt-PA静脉溶栓治疗后益处发现水平的影响因素(P<0.05)。结论 年龄、文化程度、家庭人均月收入、心理弹性、社会支持均为老年ACI患者rt-PA静脉溶栓治疗后益处发现的影响因素。

分析标准剂量rt-PA静脉溶栓联合动脉取栓治疗急性脑梗死的临床效果

目的 探究标准剂量rt-PA静脉溶栓联合动脉取栓治疗急性脑梗死的效果。方法 随机选取海阳市人民医院于2021年7月—2023年7月收治的80例急性脑梗死患者为研究对象,通过随机数表法分成溶栓组与桥接组,各40例。溶栓组运用标准量静脉溶栓治疗,桥接组在经过30 min静脉溶栓治疗之后,对治疗效果不理想的患者,进行机械取栓。比较两组的国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分以及不良反应发生情况。结果 治疗后24 h、7 d、30 d,桥接组的NIHSS评分均低于溶栓组,差异有统计学意义(P均<0.05)。桥接组的不良反应总发生率为7.50%,溶栓组为2.50%,两组对比,差异无统计学意义(χ^(2)=0.263,P>0.05)。结论 标准剂量rt-PA静脉溶栓联合动脉取栓治疗有效地促进了患者神经功能的恢复,不良反应与溶栓治疗相当,对急性脑梗死的治疗提供了有力的支持。

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。

化瘀通脉汤联合rt-PA静脉溶栓治疗气虚血瘀证脑卒中临床观察

目的:探讨化瘀通脉汤联合rt-PA静脉溶栓治疗气虚血瘀证脑卒中的临床效果。方法:回顾性选取2020年9月~2023年9月聊城市人民医院收治的100例气虚血瘀证脑卒中患者为研究对象,根据治疗方法分为研究组61例及对照组39例。研究组采用化瘀通脉汤联合rt-PA静脉溶栓治疗,对照组采用rt-PA静脉溶栓治疗,比较两组临床症状评分、凝血状态、脑血流动力学及血清标志物水平。结果:治疗后研究组美国国立卫生院卒中量表(NIHSS)评分低于对照组,卒中影响量表(SIS)、Berg平衡量表(BBS)评分高于对照组(P<0.05);治疗后研究组凝固时间(KT)、凝血反应时间(RT)高于对照组,最大振幅(MA)、凝固角(α)低于对照组(P<0.05);治疗后研究组平均脑部动脉血流速度(Vm)、收缩期血流速度(Vs)、舒张末期血流速度(Vd)高于对照组,阻力指数(RI)低于对照组(P<0.05);治疗后研究组胶质纤维酸性蛋白(GFAP)、血管性血友病因子(vWF)、血管细胞黏附分子(VCAM-1)水平低于对照组(P<0.05)。结论:化瘀通脉汤联合rt-PA静脉溶栓治疗气虚血瘀证脑卒中可以降低患者神经功能损伤,改善日常活动能力,改善凝血状态,提高脑血流灌注,降低神经炎症。

Effects of Intravenous Thrombolytic Therapy with Alteplase on Neurological Function,Coagulation Function and Serum Inflammatory Factors in Patients with Acute Cerebral Infarction

Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.

Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis

Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.

血清HDAC4和MYD88水平与急性脑梗死rt-PA静脉溶栓后出血转化的关系研究

目的探讨急性脑梗死(ACI)患者血清组蛋白去乙酰化酶4(HDAC4)和髓样分化蛋白88(MYD88)水平与重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后发生出血转化的关系。方法选取2020年5月至2022年5月在该院就诊并进行rt-PA静脉溶栓治疗的169例ACI患者作为研究对象,并根据患者进行rt-PA静脉溶栓后是否发生出血转化将其分为转化组(46例)和非转化组(123例),另外选取同期在该院进行体检的156例体检健康者作为对照组。采用酶联免疫吸附试验对各组血清HDAC4、MYD88水平进行检测,并对转化组和非转化组的一般资料进行比较;采用Pearson相关对ACI患者血清HDAC4和MYD88水平的相关性进行分析;采用多因素Logistic回归分析影响ACI患者rt-PA静脉溶栓后出血转化的相关因素;进一步通过受试者工作特征(ROC)曲线评估HDAC4、MYD88水平及二者联合对ACI患者rt-PA静脉溶栓后出血转化的诊断价值。结果ACI组血清HDAC4水平低于对照组,血清MYD88水平高于对照组,差异均有统计学意义(P<0.05);非转化组和转化组ACI患者的性别、年龄、体重指数、空腹血糖及高血脂、冠心病占比比较,差异均无统计学意义(P>0.05),而患者心房颤动占比、美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间比较,差异均有统计学意义(P<0.05);转化组较非转化组血清HDAC4水平降低,血清MYD88水平升高,差异有统计学意义(P<0.05);Pearson相关分析结果显示,ACI患者血清HDAC4水平与MYD88呈负相关(r=-0.401,P<0.001);多因素Logistic回归分析显示,心房颤动、发病至溶栓时间、NIHSS评分、MYD88水平是ACI患者rt-PA静脉溶栓后发生出血转化的危险因素,HDAC4水平是ACI患者rt-PA静脉溶栓后发生出血转化的保护因素(P<0.05);血清HDAC4、MYD88联合检测ACI患者rt-PA静脉溶栓后发生出血转化的曲线下面积为0.876,灵敏度和特异度分别为65.22%和98.37%,优于HDAC4和MYD88单独诊断(Z二者联合-HDAC4=2.298,P=0.022;Z二者联合-MYD88=2.545,P=0.011)。结论ACI患者血清HDAC4和MYD88水平与rt-PA静脉溶栓后发生出血转化密切相关。

rt-PA静脉溶栓对AIS患者机械取栓后血栓面积及病理成分的影响

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓对急性缺血性脑卒中(AIS)患者机械取栓后血栓面积及病理成分的影响。方法选取2022年1-12月该院卒中中心进行机械取栓手术的120例AIS患者作为研究对象,根据治疗方式分为桥接治疗组(62例)和单纯机械取栓组(58例),桥接治疗组接受rt-PA静脉溶栓+机械取栓治疗,单纯机械取栓组仅接受机械取栓治疗。收集两组患者的一般资料,比较两组美国国立卫生研究院卒中量表(NIHSS)评分及改良Rankin量表(mRS)评分,并对所有机械取栓收集的血栓标本进行处理,分析两组患者血栓特征。结果两组基线资料比较,差异均无统计学意义(P>0.05)。两组治疗前NIHSS与mRS评分比较,差异均无统计学意义(P>0.05);治疗后,两组NIHSS、mRS评分均较治疗前降低,差异均有统计学意义(P<0.05),但两组间比较,差异均无统计学意义(P>0.05)。两组术后血管成功再通率及90 d预后良好率比较,差异均无统计学意义(P>0.05)。两组血栓中的红细胞占比、纤维蛋白/血小板占比、白细胞占比比较,差异均无统计学意义(P>0.05),但桥接治疗组的血栓总面积、红细胞面积、纤维蛋白/血小板面积、白细胞面积明显小于单纯机械取栓组,差异均有统计学意义(P<0.05)。结论rt-PA静脉溶栓可明显减少AIS患者机械取栓后的血栓面积,同时对血栓主要病理成分的面积也有缩减作用,但对血栓主要病理成分的占比不构成影响。

急性缺血性脑卒中病人rt-PA静脉溶栓后预后不良的列线图风险预测模型构建与评估

目的:探讨急性缺血性脑卒中(AIS)病人重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后不良预后的影响因素,并构建其列线图风险预测模型。方法:将123例接受rt-PA静脉溶栓治疗的急性缺血性脑卒中病人作为研究对象,于治疗后随访3个月,根据mRS评分,分为预后良好组和预后不良组,通过单、多因素logistic模型分析其预后不良的影响因素。将回归分析中具有统计学意义的变量作为预测因子,利用R语言,构建AIS病人经rt-PA静脉溶栓治疗后预后不良的列线图风险预测模型,并对模型进行验证。结果:123例AIS病人经rt-PA静脉溶栓治疗后3个月,预后良好97例(78.86%),预后不良26例(21.14%)。多因素分析结果显示,GCS评分分度高、溶栓前NIHSS评分高和入院时NLR值升高均是AIS病人rt-PA静脉溶栓治疗后预后不良的危险因素(P<0.05~P<0.01);ROC曲线验证列线图预测模型显示,该模型预测AIS病人经rt-PA静脉溶栓治疗后预后不良的曲线下面积为0.897(95%CI:0.827~0.968),灵敏度为84.6%,特异度为90.7%。Bootstrap方法重复抽样1 000次验证列线图,显示该列预测模型内部验证前后的平均绝对误差为0.032。结论:GCS评分分度高、溶栓前NIHSS评分高和入院时NLR值升高均是AIS病人rt-PA静脉溶栓治疗后预后不良的危险因素,基于这些危险因素构建的列线图风险预测模型临床准确性较高。

rt-PA静脉溶栓与丁苯酞注射液治疗急性脑梗死的疗效探究

目的研究重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓与丁苯酞注射液治疗急性脑梗死的疗效。方法100例急性脑梗死患者,应用随机数字表法分为对照组和研究组,每组50例。对照组患者采用rt-PA开展静脉溶栓治疗,研究组患者先给予丁苯酞注射液,再采用rt-PA开展静脉溶栓治疗。对比两组治疗前后血液流变学指标、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分及出血事件发生率。结果对比本组治疗前,两组治疗后全血高切粘度、全血低切粘度、血浆粘度、红细胞压积均明显降低,且研究组全血高切粘度(4.20±0.54)mPa·s、全血低切粘度(10.05±0.98)mPa·s、血浆粘度(1.39±0.40)mPa·s、红细胞压积(31.28±2.36)%均低于对照组的(4.81±0.59)mPa·s、(11.20±1.13)mPa·s、(1.87±0.45)mPa·s、(34.59±3.04)%(P<0.05)。对比本组治疗前,两组治疗后NIHSS评分、mRS评分均明显降低,且研究组NIHSS评分(9.12±2.74)分、mRS评分(1.89±0.62)分低于对照组的(12.54±3.05)、(2.65±0.74)分(P<0.05)。研究组出血事件发生率4.00%低于对照组的18.00%(P<0.05)。结论对于接受静脉溶栓治疗的急性脑梗死患者,在采用rt-PA开展静脉溶栓治疗前应用丁苯酞注射液,可更加有效地改善患者血液流变学,有利于增强神经功能修复效果,改善其预后,还可减少出血事件发生,提高静脉溶栓治疗的安全性。

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.

血清sLOX-1、ESM-1对急性缺血性脑卒中患者rt-PA静脉溶栓后发生出血转化的预测价值

目的探讨血清可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)、内皮细胞特异性分子-1(ESM-1)对急性缺血性脑卒中(AIS)患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后发生出血转化(HT)的预测价值。方法选择2020年1月至2022年6月在宝鸡市人民医院接受rt-PA静脉溶栓治疗的AIS患者320例为研究对象,根据治疗后头颅CT复查结果分为HT组和非HT组,采用酶联免疫吸附试验检测两组患者的血清sLOX-1、ESM-1水平,并进行比较;采多因素Logistic回归分析rt-PA静脉溶栓后发生HT的影响因素;采用受试者工作特征(ROC)曲线分析血清sLOX-1、ESM-1对rt-PA静脉溶栓后发生HT的预测价值。结果治疗36 h后,47例患者发生HT(HT组),HT发生率为14.69%(47/320),剩余273例未发生HT患者为非HT组。HT组年龄、合并高血压患者占比、入院时NIHSS评分、治疗前血清sLOX-1和ESM-1水平高于非HT组(P<0.05)。多因素Logistic回归分析结果显示,入院时NIHSS评分>13.04分、血清sLOX-1>0.92 ng/mL、血清ESM-1>1.24μg/mL是AIS患者静脉溶栓后发生HT的独立危险因素(P<0.05)。治疗前血清sLOX-1、ESM-1单独及联合检测预测rt-PA静脉溶栓后发生HT的曲线下面积(AUC)分别为0.797、0.775和0.840。结论血清sLOX-1、ESM-1是AIS患者rt-PA静脉溶栓后发生HT的影响因素,二者联合检测对其具有较高的预测价值。