多模式MRI指导缺血性脑卒中静脉溶栓降低出血转化的研究  

Multi-mode MRI-based intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA) reduces hemorrhagic transformation in ischemic stroke patients

作　　者：林悦涵[1] 楼敏[1] 朱仁洋[1] 严余清[1] 陈智才[1] 丁美萍[1] 

机构地区：[1]浙江大学医学院附属第二医院神经科,浙江杭州310009

出　　处：《浙江大学学报（医学版）》2012年第6期665-671,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省重大科技专项国际科技合作项目(2008C14078);浙江省卫生厅省部共建项目(WKJ2010-2-010)

摘　　要：目的:对比CT与多模式MRI指导下缺血性脑卒中静脉溶栓治疗后出血转化的差异,明确多模式MRI指导溶栓的安全性。方法:回顾分析2009年6月-2011年10月期间接受静脉重组组织型纤溶酶原激活剂(rtPA)溶栓治疗的缺血性脑卒中患者资料,包括性别、年龄、既往史、溶栓时间、基线NIHSS、血压、血糖、电解质、凝血谱和心电图,以及溶栓后CT与MRI检查等,按照中国缺血性卒中亚型(CISS)标准予以病因分组。结果:共113例患者接受静脉rtPA治疗,平均年龄:(66±12)岁,男性74例,占65.5%,溶栓前美国国立卫生院卒中量表(National Institute of Health StrokeScale,NIHSS)评分12.4±6.5,发病至溶栓时间:(259.7±131.7)min;溶栓后24 h复查发现,34例(30.1%)出现溶栓后出血转化,其中9例(8%)为症状性出血。Logistic回归分析发现,多模式MRI指导下溶栓后的出血转化风险明显减少(OR=0.599,95%CI:0.373～0.962;P=0.034)。结论:多模式MRI指导溶栓相对于CT筛查,在静脉rtPA溶栓治疗后显示更低的出血转化率。Objective： To compare the safety of intravenous thrombolytic therapy with recombinant tissue plasminogen activator（rtPA） in ischemic patients under the guidance of CT and multi-mode MRI.Methods： The clinical,laboratory,and radiologic data from 113 consecutive hyperacute ischemic patients who received intravenous rtPA therapy from June 2009 to October 2011 was retrospectively reviewed.The rate of hemorrhagic transformation（HT） and the clinical outcome between CT and multi-mode MRI was compared.Etiological subgroups were classified according to Chinese ischemic stroke subclassification（CISS）.Results： Among 113 patients treated with intravenous rtPA,the mean age was 66±12 years,74（65.5%） were man,the pretreatment National Institutes of Health Stroke Scale score（NIHSS） was 12.4±6.5,and time from symptom onset to therapy was 259.7±131.7 min.Postlytic radiological HT was found in 34 patients（30.1%）.Symptomatic ICH occurred in 9 patients（8%）.Logistic regression analysis suggested that multi-mode MRI was an independent predictor of reduced risk of HT.Conclusion： The risk of hemorrhagic complications is lower in patients receiving intravenous thrombolytic therapy with rtPA guided by multi-mode MRI than those guided by CT scan.

关 键 词：磁共振成像 脑缺血 药物疗法 脑梗死 药物疗法 血栓溶解疗法 多模式MRI 静脉溶栓 脑梗死 RTPA 出血转化 临床研究 

分 类 号：R743.33[医药卫生—神经病学与精神病学]