低剂量与标准剂量阿替普酶静脉溶栓治疗高龄急性缺血性脑卒中患者的临床疗效对比
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摘要
目的:探讨低剂量(0.6mg/kg)与标准剂量(0.9mg/kg)阿替普酶静脉溶栓治疗高龄(年龄>80岁)急性脑梗死患者的疗效与安全性。方法:将40例发病3h内的高龄脑卒中患者分为阿替普酶低剂量组(n=21)和标准剂量组(n=19),比较两组患者的一般情况、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、出血事件、发病90d改良Rankin量表(mRS)评分和90d死亡率。结果:低剂量组与标准剂量组患者一般临床资料、基线NIHSS评分、溶栓24h及溶栓7dNIHSS差异无统计学意义。低剂量组与标准剂量组患者出血性脑梗死发生率、发病90d死亡率以及90d的mRS评分0～2分患者比例差异均无统计学意义。结论:高龄急性缺血性脑卒中患者早期低剂量与标准剂量阿替普酶静脉溶栓的疗效及安全类似。
Objective:To investigate the efficacy and safety of intravenous thrombolytic therapy with low-dose(0.6 mg/kg)or standard-dose(0.9 mg/kg)alteplase in the treatment of elderly patients(age>80 years)with acute ischemic stroke.Methods:Fourty elderly patients with acute ischemic stroke within 3 hours after onset were randomly divided into two groups:21 patients in the low-dose alteplase group and 19 patients in the standard-dose alteplase group.The general situation,National Institute of Health stroke scale(NIHSS)scores,bleeding events,modified Rankin Scale(mRS)score after 90 days of morbidity,and 90-day mortality were compared between the two groups.Results:There was no significant difference in general clinical data,baseline NIHSS score,and 24 hand 7 dNIHSS score between low-dose group and standard-dose group.And no significant difference was found in the incidence of intracranial hemorrhage,the 90-day mortality,and the ratio of 90-day mRS score of 0-2 between the two groups.Conclusions:Low-dose alteplase has similar efficacy and safety profile compared with standard-dose alteplase in elderly patients with acute ischemic stroke.
Objective:To investigate the efficacy and safety of intravenous thrombolytic therapy with low-dose(0.6 mg/kg)or standard-dose(0.9 mg/kg)alteplase in the treatment of elderly patients(age>80 years)with acute ischemic stroke.Methods:Fourty elderly patients with acute ischemic stroke within 3 hours after onset were randomly divided into two groups:21 patients in the low-dose alteplase group and 19 patients in the standard-dose alteplase group.The general situation,National Institute of Health stroke scale(NIHSS)scores,bleeding events,modified Rankin Scale(mRS)score after 90 days of morbidity,and 90-day mortality were compared between the two groups.Results:There was no significant difference in general clinical data,baseline NIHSS score,and 24 hand 7 dNIHSS score between low-dose group and standard-dose group.And no significant difference was found in the incidence of intracranial hemorrhage,the 90-day mortality,and the ratio of 90-day mRS score of 0-2 between the two groups.Conclusions:Low-dose alteplase has similar efficacy and safety profile compared with standard-dose alteplase in elderly patients with acute ischemic stroke.
引文
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[12]玄丽慧,张娴娴,易琼,等.低剂量重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死有效性及安全性研究[J].中华老年心脑血管病杂志,2013,15(10):1093-1095.
[13]YANG J,YU F,LIU H,et al.A retrospective study of thrombolysis with 0.6mg/kg recombinant tissue plasminogen activator(rt-PA)in mild stroke[J].Sci Rep,2016,6:31344.
[14]WANG X,ROBINSON T G,LEE T H,et al.Low-dose vs standard-dose alteplase for patients with acute ischemic stroke:secondary analysis of the ENCHANTED randomized clinical trial[J].JAMA Neurol,2017,74(11):1328-1335.
[15]LIU M,PAN Y,ZHOU L,et al.Predictors of postthrombolysis symptomatic intracranial hemorrhage in Chinese patients with acute ischemic stroke[J].PLoS One,2017,12(9):e0184646.
[16]DONG Y,CAO W,CHENG X,et al.Low-dose intravenous tissue plasminogen activator for acute ischaemic stroke:an alternative or a new standard?[J].Stroke Vasc Neurol,2016,1(3):115-121.
[2]杨瑛,赵李克,曹英华.早期个性化心理护理在脑卒中患者治疗中的应用[J].中国临床医学,2016,23(3):405-407.
[3]MISHRA N K,AHMED N,ANDERSEN G,et al.Thrombolysis in very elderly people:controlled comparison of SITS international stroke thrombolysis registry and virtual international stroke trials archive[J].BMJ,2010,341:c6046.
[4]IST-3 COLLABORATIVE GROUP,SANDERCOCK P,WARDLAW J M,et al.The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6hof acute ischaemic stroke(the third international stroke trial[IST-3]):a randomised controlled trial[J].Lancet,2012,379(9834):2352-2363.
[5]ANDERSON C S,ROBINSON T,LINDLEY R I,et al.Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke[J].N Engl J Med,2016,374(24):2313-2323.
[6]EMBERSON J,LEES K R,LYDEN P,et al.Effect of treatment delay,age,and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J].Lancet,2014,384(9958):1929-1935.
[7]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[8]Nakagawara J,Minematsu K,Okada Y,et al.Thrombolysis with 0.6 mg/kg intravenous alteplase for acute ischemic stroke in routine clinical practice:the Japan post-Marketing Alteplase Registration Study(J-MARS)[J].Stroke,2010,41(9):1984-1989.
[9]Yamaguchi T,Mori E,Minematsu K,et al.Alteplase at 0.6mg/kg for acute ischemic stroke within 3hours of onset:Japan Alteplase Clinical Trial(J-ACT)[J].Stroke,2006,37(7):1810-1815.
[10]XU A D,WANG Y J,WANG D Z,et al.Consensus statement on the use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke by the Chinese stroke therapy expert panel[J].CNS Neurosci Ther,2013,19(8):543-548.
[11]POWERS W J,RABINSTEIN A A,ACKERSON T,et al.2018Guidelines for the early management of patients with acute ischemic stroke:A guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2018,49(3):e46-e110.
[12]玄丽慧,张娴娴,易琼,等.低剂量重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死有效性及安全性研究[J].中华老年心脑血管病杂志,2013,15(10):1093-1095.
[13]YANG J,YU F,LIU H,et al.A retrospective study of thrombolysis with 0.6mg/kg recombinant tissue plasminogen activator(rt-PA)in mild stroke[J].Sci Rep,2016,6:31344.
[14]WANG X,ROBINSON T G,LEE T H,et al.Low-dose vs standard-dose alteplase for patients with acute ischemic stroke:secondary analysis of the ENCHANTED randomized clinical trial[J].JAMA Neurol,2017,74(11):1328-1335.
[15]LIU M,PAN Y,ZHOU L,et al.Predictors of postthrombolysis symptomatic intracranial hemorrhage in Chinese patients with acute ischemic stroke[J].PLoS One,2017,12(9):e0184646.
[16]DONG Y,CAO W,CHENG X,et al.Low-dose intravenous tissue plasminogen activator for acute ischaemic stroke:an alternative or a new standard?[J].Stroke Vasc Neurol,2016,1(3):115-121.