阿替普酶静脉溶栓治疗急性脑梗死血管再闭塞的影响因素
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摘要
目的探讨急性脑梗死静脉溶栓治疗的血管再闭塞情况及其危险因素。方法回顾性选取急性脑梗死静脉溶栓患者资料,观察年龄、性别、心房颤动史、高血压史、高脂血症、既往脑卒中史、吸烟史、糖尿病病史、血糖、收缩压、美国国立卫生研究院脑卒中量表(NIHSS)评分、起病-溶栓时间等指标与再闭塞的关系。结果再闭塞组与无再闭塞组年龄、性别、心房颤动史、高血压史、高脂血症、既往脑卒中史、吸烟史无显著差异(P>0. 05);糖尿病病史、血糖、收缩压、NIHSS评分、起病-溶栓时间差异具有显著性(P<0. 05)。Logistic回归分析显示:糖尿病病史、血糖、收缩压、NIHSS评分、起病-溶栓时间与再闭塞显著相关。结论糖尿病病史、血糖、收缩压、NIHSS评分、起病-溶栓时间是再闭塞的独立危险因素。
Objective To investigate the association between no recanalization and recanalization of acute cerebral infarction patients of intravenous thrombolysis after intravenous thrombolysis with alteplase.Methods The indexes of patients with acute cerebral infarction who underwent intravenous thrombolysis were collected,such as age,sex and history of hypertension,diabetes mellitus,smoking,and the levels of systolic pressure,blood glucose,NIHSS score and onset-thrombolysis time. Results There were no significant differences in age,sex,atrial fibrillation,history of hypertension ateral between the two groups( P>0.05). There were significant differences in history of diabetes mellitus,smoking,and the levels of systolic pressure,blood glucose,NIHSS score and onset-thrombolysis time between the two groups( P<0.05).The Logistic regression analysis showed that diabetes( OR = 4.02,P = 0.036),systolic pressure ( OR= 10.86,P= 0.001),blood glucose( OR= 10.26,P= 0.026),NIHSS score( OR= 1.29,P= 0.001),and onset-thrombolysis time( OR= 1.04,P = 0.042) were significantly associated with no recanalization.Conclusions The history of diabetes,the levels of systolic pressure,blood glucose,NIHSS score and onset-thrombolysis time are independent risk factors of no recanalization in patients of intravenous thrombolysis after intravenous thrombolysis with alteplase.
Objective To investigate the association between no recanalization and recanalization of acute cerebral infarction patients of intravenous thrombolysis after intravenous thrombolysis with alteplase.Methods The indexes of patients with acute cerebral infarction who underwent intravenous thrombolysis were collected,such as age,sex and history of hypertension,diabetes mellitus,smoking,and the levels of systolic pressure,blood glucose,NIHSS score and onset-thrombolysis time. Results There were no significant differences in age,sex,atrial fibrillation,history of hypertension ateral between the two groups( P>0.05). There were significant differences in history of diabetes mellitus,smoking,and the levels of systolic pressure,blood glucose,NIHSS score and onset-thrombolysis time between the two groups( P<0.05).The Logistic regression analysis showed that diabetes( OR = 4.02,P = 0.036),systolic pressure ( OR= 10.86,P= 0.001),blood glucose( OR= 10.26,P= 0.026),NIHSS score( OR= 1.29,P= 0.001),and onset-thrombolysis time( OR= 1.04,P = 0.042) were significantly associated with no recanalization.Conclusions The history of diabetes,the levels of systolic pressure,blood glucose,NIHSS score and onset-thrombolysis time are independent risk factors of no recanalization in patients of intravenous thrombolysis after intravenous thrombolysis with alteplase.
引文
1 GBD 2016 Couses of Death Collaborators.Global,regional,and national age-sex specific mortality for 264 causes of death,1980-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet,2017;390(10100):1151-210.
2重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组.重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版)[J].中华内科杂志,2012;51(12):1006-10.
3 Schmuling S,Rudolf J,Strotmanntack T,et al.Acetylsalicylic acid pretreatment,concoimtant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke[J].Cerebrovasc Dis,2003;16(3):183-90.
4林念童.急性缺血性脑卒中阿替普酶溶栓预后影响因素分析临床研究[D].广州:南方医科大学,2012.
5中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经学杂志,2015;48(4):246-57.
6 Muresan IP,Favrole P,Levy P,et al.Very early neurologic improvement after intravenous thrombolysis[J].Arch Neurol,2010;67:1323-8.
7 Tomsick T,Broderick J,Carrozella J,et al.Revascularization results in the Interventional Management of StrokeⅡtrial[J].Am J Neuroradiol,2008;29:582-7.
8 Wang Z,Li J,Wang C,et al.Gender differences in 1 year clinical characteristics and outcomes after stroke:results from the China National Stroke Registry[J].PLoS One,2013;8(2):e56459.
9 Rha JH,Saver JL.The impact of recanalization on ischemic stroke outcome:a meta-analysis[J].Stroke,2007;38(3):967-73.
10 Chen B,Xheng Q,Yang K,et al.Thrombin mediates severe neurovascular injury during ischemia[J].Stroke,2010;41(10):2348-52.
11张彬,孙晓江,王峰,等.急性脑梗死rt-PA溶栓治疗的安全性分析[J].中国康复,2007;22(6):403-4.
12张辰昊,张佩兰,陈岩,等.阿替普酶静脉溶栓过程中栓子溶解导致临床症状加重原因探讨[J].中国现代神经疾病杂志,2013;13(4):297-301.
13 Amarenco P,Bogousslavsky J,Caplan LR,et al.New approach to stroke subtyping:the A-S-C-O(phenotypic)classification of stroke[J].Lerebrovasc Dis,2009;27(5):502-8.
14陈海栾,何超明,庞明武,等.老年急性缺血性脑卒中患者预后不良的影响因素[J].中华老年心脑血管病杂志,2017;19(1):42-6.
15周斌.急性缺血性脑卒中患者rt-PA溶栓治疗预后影响因素分析[D].苏州:苏州大学,2015.
16 Ahmed N,Wahlgren N,Brainin M,et al.Relationship of blood pressure,antihypertensive therapy,and outcome in ischemic stroke treated with intravenous thrombolysis:retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register(SITS-ISTR)[J].Stroke,2009;40(7):2442-9.
17 Mokin M,Kasshout T,Kasshout O,et al.Intravenous thrombolysis and endovascular therapy for acute ischemic stoke with internal carotid artery occlusion:a systematic review of clinical outcomes[J].Stroke,2012;43:2362-8.
18卢桃利,张蓓.1例脑梗死静脉溶栓病例的思考[J].中国卒中杂志,2018;19(6):612-5.
2重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组.重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版)[J].中华内科杂志,2012;51(12):1006-10.
3 Schmuling S,Rudolf J,Strotmanntack T,et al.Acetylsalicylic acid pretreatment,concoimtant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke[J].Cerebrovasc Dis,2003;16(3):183-90.
4林念童.急性缺血性脑卒中阿替普酶溶栓预后影响因素分析临床研究[D].广州:南方医科大学,2012.
5中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经学杂志,2015;48(4):246-57.
6 Muresan IP,Favrole P,Levy P,et al.Very early neurologic improvement after intravenous thrombolysis[J].Arch Neurol,2010;67:1323-8.
7 Tomsick T,Broderick J,Carrozella J,et al.Revascularization results in the Interventional Management of StrokeⅡtrial[J].Am J Neuroradiol,2008;29:582-7.
8 Wang Z,Li J,Wang C,et al.Gender differences in 1 year clinical characteristics and outcomes after stroke:results from the China National Stroke Registry[J].PLoS One,2013;8(2):e56459.
9 Rha JH,Saver JL.The impact of recanalization on ischemic stroke outcome:a meta-analysis[J].Stroke,2007;38(3):967-73.
10 Chen B,Xheng Q,Yang K,et al.Thrombin mediates severe neurovascular injury during ischemia[J].Stroke,2010;41(10):2348-52.
11张彬,孙晓江,王峰,等.急性脑梗死rt-PA溶栓治疗的安全性分析[J].中国康复,2007;22(6):403-4.
12张辰昊,张佩兰,陈岩,等.阿替普酶静脉溶栓过程中栓子溶解导致临床症状加重原因探讨[J].中国现代神经疾病杂志,2013;13(4):297-301.
13 Amarenco P,Bogousslavsky J,Caplan LR,et al.New approach to stroke subtyping:the A-S-C-O(phenotypic)classification of stroke[J].Lerebrovasc Dis,2009;27(5):502-8.
14陈海栾,何超明,庞明武,等.老年急性缺血性脑卒中患者预后不良的影响因素[J].中华老年心脑血管病杂志,2017;19(1):42-6.
15周斌.急性缺血性脑卒中患者rt-PA溶栓治疗预后影响因素分析[D].苏州:苏州大学,2015.
16 Ahmed N,Wahlgren N,Brainin M,et al.Relationship of blood pressure,antihypertensive therapy,and outcome in ischemic stroke treated with intravenous thrombolysis:retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register(SITS-ISTR)[J].Stroke,2009;40(7):2442-9.
17 Mokin M,Kasshout T,Kasshout O,et al.Intravenous thrombolysis and endovascular therapy for acute ischemic stoke with internal carotid artery occlusion:a systematic review of clinical outcomes[J].Stroke,2012;43:2362-8.
18卢桃利,张蓓.1例脑梗死静脉溶栓病例的思考[J].中国卒中杂志,2018;19(6):612-5.