重组组织型纤溶酶原激活剂静脉治疗轻型缺血性卒中患者的疗效分析

doi:10.3969/j.issn.1673-5765.2018.09.004

摘要/Abstract

摘要：

目的观察轻型缺血性卒中患者重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）静脉溶栓治疗的疗效及安全性。

方法收集2016年1月-2017年9月轻型缺血性卒中患者共166例作为研究对象，根据发病后有无接受 rt-PA静脉溶栓治疗将患者分为溶栓组及对照组。比较两组溶栓后24 h和7 d时美国国立卫生研究院卒中量表（National Institutes of Health stroke scale，NIHSS）评分、90 d改良Rankin评分（modified Rankin scale，mRS）、90 d缺血性卒中复发率；比较两组颅内出血、症状性颅内出血的发生率。

结果共纳入溶栓组和对照组各83例患者。溶栓组溶栓后24 h和7 d时患者NIHSS评分均低于基线 NIHSS评分，同时在治疗后各时间点（24 h、7 d）也低于对照组，差异有统计学意义。溶栓组90 d良好预后（mRS≤1分）的患者比例较对照组高（88.0% vs 71.1%，P =0.007）。溶栓组早期神经功能恶化率（NIHSS评分较基线升高≥2分）低于对照组（3.6% vs 15.6%，P =0.016）。两组患者90 d内复发率无差异（8.4% vs 10.8%，P =0.599）。溶栓组发生颅内出血发生率6.0%，对照组为1.2%，差异无统计学意义（P =0.096）。两组均未发现症状性颅内出血病例。

结论轻型缺血性卒中患者在发病后4.5 h内进行rt-PA静脉溶栓有助于改善其神经功能，并且降低早期神经功能恶化发生率，但不能降低复发率。同时溶栓治疗并不增加总的颅内出血风险及症状性颅内出血风险。

文章导读： 本研究将166例小卒中患者分为静脉溶栓组和对照组，比较其早期神经功能恶化率、复发率、疗效及颅内出血情况，结果显示静脉溶栓疗效确切，且不增加颅内出血风险。

关键词: 轻型缺血性卒中; 重组组织型纤溶酶原激活剂; 溶栓

Abstract:

Objective To observe the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute mild ischemic stroke. Methods A total of 166 eligible patients from the fist affiliated hospital of Dalian medical university from January 2016 to September 2017 were included in this study. According to whether to receive rt-PA intravenous thrombolysis, these patients were divided into thrombolysis group and control group. The following efficacy and safety outcome between two groups were compared: the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours and 7 days after thrombolysis, 90-day modified Rankin Scale (mRS), 90-day recurrent ischemic stroke, intracranial hemorrhage (ICH) and symptomatic ICH. Results 83 patients in each group. The 24-hour and 7-day NIHSS scores were all lower than the baseline NIHSS score in thrombolysis group, and the 24-hour and 7-day NIHSS scores in thrombolysis group were also lower than that in control group, and all the differences were statistically significant. The proportion of 90-day favorable outcome (mRS≤1) in thrombolysis group was higher than that in control group (88.0% vs 71.1%, P =0.007). The rate of early neurological deterioration (defined as the score of NIHSS increasing ≥2 points comparing the baseline score) in thrombolysis group was far lower than that in control group (3.6% vs 15.6%, P =0.016). The recurrence rate of stroke within 90 days between the two groups had no statistical difference (8.4% vs 10.8%, P =0.599). The incidence of ICH between the two groups also had no statistical difference (6.0% vs 1.2%, P =0.096). There was no symptomatic ICH case in two groups. Conclusion For patients with acute mild ischemic stroke, intravenous thrombolysis with rt-PA within 4.5 h from onset could improve the short-term and long-term neurological function, and reduce the incidence of early neurologic deterioration, while had no effect on recurrent stroke. The safety outcome was that thrombolytic therapy did not increase the risk of ICH and symptomatic ICH in patients with mild stroke.

Key words: Mild ischemic stroke; Recombinant tissue plasminogen activator; Thrombolysis

于若梅, 曹谡涵, 毛保义, 杨西, 陶梦醒, 孙晓培. 重组组织型纤溶酶原激活剂静脉治疗轻型缺血性卒中患者的疗效分析[J]. 中国卒中杂志, 2018, 13(09): 903-907.

YU Ruo-Mei, CAO Su-Han, MAO Bao-Yi, YANG Xi, TAO Meng-Xi, SUN Xiao-Pei. Efficacy and Safety of Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in Acute Mild#br# Ischemic Stroke[J]. Chinese Journal of Stroke, 2018, 13(09): 903-907.

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