心房颤动与缺血性卒中静脉溶栓预后的相关性  

The relation between atrial fibrillation and prognosis of intravenous thrombo｜ysis in acute ischemic stroke patients

作　　者：王贞[1] 张万里[1] 冯靓[1] 王志敏 张顺开[3] 邱伟文[4] 梁海燕[5] 朱振国[1] 韩钊[1] 牛晓婷[1] 邵蓓[1] 

机构地区：[1]温州医科大学附属第一医院神经内一科,325000 [2]台州市人民医院神经内科 [3]温州医科大学附属第三医院神经内科 [4]丽水市中心医院神经内科 [5]台州市立医院神经内科

出　　处：《中华神经科杂志》2013年第11期725-729,共5页Chinese Journal of Neurology

基　　金：浙江省科技厅公益技术研究社会发展项目（2011C33017）

摘　　要：目的探讨心房颤动与急性期缺血性卒中患者静脉溶栓早期和晚期预后的相关性。方法收集浙江西南部地区就诊于5家大型综合性医院的123例在4．5h内接受重组组织型纤溶酶原激活物（rt—PA）静脉溶栓治疗的急性缺血性卒中患者，根据是否合并心房颤动将其分为心房颤动组（n=52）和无心房颤动组（n=71），总结两组患者的基线特点和预后，通过Logistic回归分析研究心房颤动与静脉溶栓预后的相关性。结果心房颤动组患者的基线NIHSS评分（分）明显高于无心房颤动组（14与11，U=1236．000，P=0．002），心房颤动组溶栓治疗后2h和7d的NIHSS评分降低程度与无心房颤动组相比差异无统计学意义。心房颤动组90d良好预后（改良Rankin量表评分≤1分）的患者比例较无心房颤动组低[21．2％（11／52）与43．7％（31／71），x^2=6．763，P=0．009]，Logistic回归分析显示基线NIHSS评分〉10分（OR=0．226，95％CI 0．093—0．547，P=0．001）与缺血性卒中溶栓患者的90d良好预后存在相关性，心房颤动（OR=0．551，95％CI 0．209—1．452，P=0．228）与90d良好预后无明显相关性。结论心房颤动与溶栓的早期和晚期预后均无明显相关性。Objective To explore the relation between atrial fibrillation （AF） and short- and long- term prognosis of acute ischemic stroke treated with intravenous thrombolysis. Methods One hundred and twenty-three ischemic stroke patients who came from 5 large general hospitals in southwestern region of Zhejiang treated with recombinant tissue plasminogen activator within 4. 5 hours from stroke onset were enrolled in this study. Patients were classified into 2 groups based on the presence or absence of AF： AF group （n = 52） and non-AF group （n =71 ）. Baseline characteristics and prognosis were compared between groups, and the correlation between AF and functional outcome after intravenous thrombolysis was analyzed by logistic regression analysis. Results The baseline National Institute of Health Stroke Scale （NIHSS） score in AF group was significantly higher than that of non-AF group （ 14 vs 11, U = 1236. 000, P = 0. 002）. No difference was found for the reduction of NIHSS at 2 h and 7 d after thrombolytic therapy between these 2 groups. At day 90, patients in AF group accounted for less favorable outcome （ Modified Rankin Scale score ≤ 1 ） than that in non-AF group（21.2% （11/52） vs 43.7% （31/71）, x^2 = 6. 763, P = 0. 009）. Logistic regression analysis revealed that baseline NIHSS score 〉 10 was significantly associated with a lower rate of favorable outcome at day 90 after thrombolysis （ OR = 0. 226, 95% CI 0. 093-0. 547, P = 0. 001 ）, whereas AF was not an independent influencing factors for the rate of favorable outcome at day 90 （OR=0.551, 95%CI 0.209-1.452, P=0.228）. Conclusion AF is irrelevant to short- and long- term prognosis of thrombolysis.

关 键 词：脑梗死 心房颤动 组织型纤溶酶原激活物 血栓溶解疗法 预后 

分 类 号：R743[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]