【摘要】 目的探讨轻型急性缺血性卒中rt-PA静脉溶栓的疗效和安全性及预后不良的危险因素。方法前瞻性分析从2016年1月～2018年5月在深圳市6个卒中中心接受rt-PA静脉溶栓的急性缺血性卒中患者临床资料共224例,将美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)≤5分定义为轻型卒中(minor stroke,MS),共116例,NIHSS> 5分为非轻型卒中(non-minor stroke,NMS),共108例。比较两组基线资料、两组治疗后90 d改良Rankin评分(mRS)、治疗后7 d内症状性颅内出血(symptomatic intracerebral hemorrhage,s ICH)及早期神经功能恶化(early neurological deterioration,END)发生率、90 d死亡率的差异。运用单因素及多因素logistic回归分析探讨影响rt-PA静脉溶栓的MS患者预后不良的危险因素。结果两组基线资料中,与NMS组相比,MS组心源性栓塞型卒中比例更低(7. 8%vs 17. 6%,P=0. 026),而小动脉闭塞型卒中比例明显更高(41. 4%vs24. 1%,P=0. 006)。疗效性上,MS组90 d预后良好(mRS≤2分)比例明显高于NMS组(87. 9%vs 63%,OR6. 099,95%CI 2. 650～14. 040,P <0. 001)。安全性上,MS组7 d内END发生率高于NMS组(5. 2%vs 4. 6%); 7 d内s ICH发生率低于NMS组(4. 3%vs 6. 5%); 90 d内死亡率低于NMS组(1. 7%vs 7. 4%),校正前后差异均无统计学意义。单因素Logistic回归分析提示即使接受静脉溶栓治疗,大动脉粥样硬化型卒中、END、既往缺血性脑卒中病史、既往接受抗血小板治疗与MS患者预后不良相关,而多因素logistic回归分析提示只有END与预后不良相关。结论与NMS相比,MS患者接受rt-PA静脉溶栓有助于改善90 d的神经功能预后,安全性与NMS相似。即使接受rt-PA静脉溶栓治疗,END仍然是MS患者预后不良的独立危险因素。更多还原

【Abstract】 Objective To explore the efficacy and safety of intravenous thrombolysis with rt-PA for mild acute ischemic stroke,and the risk factors of poor prognosis in these patients. Methods From January 2016 to May 2018,we prospectively analysed analyzed 224 patients with acute ischemic stroke received intravenous thrombolysis with rt-PA in 6 stroke centers in Shenzhen,minor stroke( MS) was defined as National Institutes of Health Stroke Scale( NIHSS) ≤5,including 116 patients,non-minor stroke( NMS) was defined as NIHSS > 5,including 108 patients. The baseline data,the modified Rankin scale( mRS) in the 90-day,the rate of symptomatic intracerebral hemorrhage( s ICH) and early neurological deterioration( END) during 7 days after treatment,the mortality in the 90-day between the two groups were compared. Univariate and multivariate logistic regression analysis was used to explore the risk factors of poor prognosis in MS patients treated with rt-PA. Results Compared with NMS,the proportion of cardiogenic embolism stroke in MS was significantly lower( 7. 8% vs17. 6%,P = 0. 026),while the proportion of small artery occlusive stroke was significantly higher( 41. 4% vs 24. 1%,P =0. 006). In efficacy,the proportion of the good outcome in the 90-day( mRS≤2) in MS group was obviously significantly higher than that in NMS group( 87. 9% vs 63%,OR 6. 099,95% CI 2. 650 ～ 14. 040,P < 0. 001). In safety,compared with NMS,the rate of END was higher( 5. 2% vs 4. 6%),the rate of s ICH was lower( 4. 3% vs 6. 5%),the mortality in the 90-day was lower( 1. 7% vs 7. 4%) in the MS group,there was no significant difference before and after correcting confounding factors. In Univariate logistic regression analysis,even received rt-PA,large artery atherosclerotic stroke,END,previous history of ischemic stroke and previous antiplatelet therapy were associated with poor prognosis in MS patients,while in multivariate logistic regression analysis,only END was associated with poor prognosis. Conclusion Compared with NMS,intravenous thrombolysis with rt-PA for MS patients can improve the 90-day neurological function,the safety is similar as NMS.Even received rt-PA,END is still an independent risk factor for poor prognosis in MS patients.更多还原