急性缺血性卒中患者静脉溶栓治疗的临床预后影响因素分析  

Efficacy and outcome predictors of intravenous thrombolysis for patients with acute ischemic stroke

作　　者：凌倚峰[1] 程忻[1] 杨璐萌[1] 方堃[1] 曹文杰[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华神经科杂志》2014年第7期449-454,共6页Chinese Journal of Neurology

基　　金：上海市科委西医引导类项目（124119a8100）;上海市公共卫生体系建设三年行动计划资助项目（GW3-18）

摘　　要：目的 通过分析华山医院接受静脉溶栓治疗的急性缺血性卒中患者的预后,探讨静脉溶栓治疗良好结局的相关预测因素.方法 回顾性分析2008年1月至2013年5月华山医院所有接受静脉溶栓治疗的急性缺血性卒中患者的临床资料.按3个月临床结局改良Rankin量表评分将患者分为结局良好组（＜2分）及结局不良组（≥2分）,进行单因素及多因素相关分析.结果 连续纳入148例急性缺血性卒中患者,在4.5h时间窗内溶栓患者的结局良好比例为52.4％ （65/124）,明显优于超时间窗的患者的20.8％ （5/24;x2=8.048,P=0.005）.单因素分析显示：患者年龄（U=2 146.000,P=0.025）TOAST分型（x2=11.412,P=0.010）、牛津郡社区卒中项目（OCSP）分型（x2=17.409,P=0.001）、基线血糖（U=1 446.500,P＜0.01）、基线纤维蛋白原（U=1689.000,P=0.038）、入院时美国国立卫生研究院卒中量表（NIHSS）评分（U=1 140.000,P＜0.01）、24 h NIHSS评分（U=458.000,P＜0.01）及早期症状改善（24 h NIHSS评分降低≥4分或者降至0分;x2=19.576,P＜0.01）是影响临床结局的因素.多因素回归分析提示的独立预测因素有：年龄（OR=0.943,95％ CI 0.892 ～0.996,P=0.024）、基线纤维蛋白原（OR=0.448,95％ CI 0.208～0.963,P=0.040）、基线NIHSS评分（OR=0.749,95％ CI 0.663 ～ 0.845,P＜0.01）和早期症状改善（OR=14.970,95％ CI 4.460～50.249,P＜0.01）.结论 静脉溶栓治疗的疗效有明确的时间依赖性.年龄、基线纤维蛋白原、基线NIHSS评分和早期症状改善为静脉溶栓3个月结局的独立预测因素.Objective To determine factors associated with favorable clinical outcome in acute ischemic stroke patients who received intravenous thrombolysis.Methods Patients treated with intravenous recombinant tissue plasminogen activator （rt-PA） between January 1,2008 and May 31,2013 were recruited.Favorable outcome was defined as modified Rankin scale （mRS） score 〈 2 at 3 months.The baseline characteristics were compared by univariate and multivariate analysis.Results Of all the 148 patients studied,within the 4.5-hour time window,the rate of patients with a favorable outcome was 52.4% （65/124）,significantly better than those beyond the time window（20.8% （5/24）,x2 =8.048,P =0.005）.Univariate analysis showed that age （U =2 146.000,P =0.025）,TOAST classification （x2 =11.412,P =0.010）,Oxfordshire Community Stroke Project （OCSP） classification （x2 =17.409,P =0.001）,baseline blood glucose （U =1 446.500,P 〈 0.01）,baseline fibrinogen （U =1 689.000,P =0.038）,admission NIHSS score （U =1 140.000,P 〈 0.01）,24-hour NIHSS score （U =458.000,P 〈0.01）,and early symptom improvement （24-hour NIHSS score decreased ≥ 4 points,or down to 0 point;x2 =19.576,P 〈 0.01） were the factors associated with clinical outcomes.Multivariate analysis revealed that age （odds ratio （OR） =0.943,95% confidence interval （CI） 0.892-0.996,P =0.024）,baseline fibrinogen （OR =0.448,95% CI 0.208-0.963,P =0.040）,baseline NIHSS score （OR =0.749,95% CI 0.663-0.845,P 〈 0.01）,and early symptom improvement （OR =14.970,95% CI 4.460-50.249,P 〈 0.01） were independent predictors of clinical outcomes.Conclusions The effect of intravenous thrombolysis on clinical outcomes of acute ischemic stroke patients is time-dependent.Age,baseline NIHSS score,baseline fibrinogen level,and early symptom improvement are independent predictors of clinical outcomes after intravenous thrombolysis.

关 键 词：脑缺血 卒中 血栓溶解疗法 组织型纤溶酶原激活物 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]