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| 静脉溶栓治疗不同病因急性缺血性脑卒中的疗效比较 |
| 朱宣△,张敏敏△,沈红健,沈芳,陈蕾,姜一,袁绘,张永巍*,吴涛,邓本强 |
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(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 比较不同病因急性缺血性脑卒中（AIS）患者静脉溶栓治疗的有效性和安全性。方法 回顾性连续纳入2016年1月至2020年12月我中心接受阿替普酶静脉溶栓治疗的AIS患者，收集患者的临床资料，并根据Org 10172急性脑卒中治疗试验（TOAST）病因分型标准将患者分为LAA、SAO、CE、其他明确病因（SOE）和不明原因（SUE）组。比较不同病因组AIS患者静脉溶栓治疗后24 h早期有效率、90 d预后良好率及出血转化率。采用多因素logistic回归分析探讨TOAST病因分型是否为静脉溶栓治疗后90 d预后的影响因素。结果 共538例AIS患者入组，其中LAA组140例（26.0%）、SAO组233例（43.3%）、CE组98例（18.2%）、SUE组58例（10.8%）、SOE组9例（1.7%）。静脉溶栓治疗后24 h早期有效的AIS患者共210例（39.0%），其中LAA组56例（40.0%）、SAO组85例（36.5%）、CE组41例（41.8%）、SUE组26例（44.8%）、SOE组2例（22.2%），各组间早期有效率比较差异无统计学意义（P=0.596）。443例（82.3%）AIS患者治疗后90 d预后良好（改良Rankin量表评分为0~2分），其中LAA组108例（77.1%）、SAO组201例（86.3%）、CE组82例（83.7%）、SUE组45例（77.6%）、SOE组7例（77.8%），各组间90 d预后良好率比较差异无统计学意义（P=0.147）。36例（6.7%）AIS患者治疗后有出血转化，其中LAA组10例（7.1%）、SAO组11例（4.7%）、CE组11例（11.2%）、SUE组3例（5.2%）、SOE组1例（11.1%），各组间出血转化率比较差异无统计学意义（P=0.209）。多因素logistic回归分析结果显示，TOAST病因分型不是AIS患者静脉溶栓治疗后90 d预后的影响因素。结论 不同病因AIS患者中，静脉溶栓治疗的有效性和安全性无显著差异。 |
| 关键词: 急性缺血性脑卒中 静脉溶栓 阿替普酶 病因 预后 出血转化 |
| DOI：10.16781/j.0258-879x.2022.01.0049 |
| 投稿时间：2021-09-18 |
| 基金项目:上海市临床重点专科项目（shslczdzk06101），上海市浦江人才计划（2019PJD051） |
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| Efficacy of intravenous thrombolysis on acute ischemic stroke with different etiology types: a comparative study |
| ZHU Xuan△,ZHANG Min-min△,SHEN Hong-jian,SHEN Fang,CHEN Lei,JIANG Yi,YUAN Hui,ZHANG Yong-wei*,WU Tao,DENG Ben-qiang |
(Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To compare the efficacy and safety of intravenous thrombolysis in acute ischemic stroke (AIS) with different etiology types.Methods AIS patients who received intravenous thrombolysis with alteplase in our center from Jan. 2016 to Dec. 2020 were retrospectively included, and the clinical data were collected. According to the classification of Trial of Org 10172 in Acute Stroke Treatment (TOAST), the patients were divided into large artery atherosclerosis (LAA) group, small artery occlusion (SAO) group, cardioembolism (CE) group, stroke of other determined etiology (SOE) group and stroke of undetermined etiology (SUE) group. The early effective rate 24 h after treatment, good prognosis rate 90 d after treatment and hemorrhagic transformation rate were compared among different etiology groups. Multivariate logistic regression analysis was used to explore whether TOAST classification was an influencing factor of prognosis 90 d after intravenous thrombolysis.Results A total of 538 AIS patients were enrolled, including 140 (26.0%) patients in the LAA group, 233 (43.3%) in the SAO group, 98 (18.2%) in the CE group, 58 (10.8%) in the SUE group and 9 (1.7%) in the SOE group. It was effective in 210 (39.0%) AIS patients 24 h after intravenous thrombolysis, including 56 (40.0%) patients in the LAA group, 85 (36.5%) in the SAO group, 41 (41.8%) in the CE group, 26 (44.8%) in the SUE group and 2 (22.2%) in the SOE group, showing no significant difference (P=0.596). There were 443 (82.3%) AIS patients with good prognosis (modified Rankin scale score of 0-2) 90 d after treatment, including 108 (77.1%) patients in the LAA group, 201 (86.3%) in the SAO group, 82 (83.7%) in the CE group, 45 (77.6%) in the SUE group and 7 (77.8%) in the SOE group, showing no significant difference (P=0.147). Thirty-six (6.7%) AIS patients had hemorrhagic transformation after treatment, including 10 (7.1%) patients in the LAA group, 11 (4.7%) in the SAO group, 11 (11.2%) in the CE group, 3 (5.2%) in the SUE group and 1 (11.1%) in the SOE group, showing no significant difference (P=0.209). Multivariate logistic regression analysis showed that TOAST classification was not a prognostic factor of AIS patients 90 d after intravenous thrombolysis.Conclusion There are no significant differences in the efficacy or safety of intravenous thrombolysis in AIS patients with different etiology types. |
| Key words: acute ischemic stroke intravenous thrombolysis alteplase etiology prognosis hemorrhagic transformation |
