磁共振成像快速评价指导的觉醒型缺血性卒中患者的静脉溶栓治疗  

Fast magnetic resonance imaging-based thrombolysis in patients with wake-up ischemic strokes

作　　者：白青科[1] 赵振国[2] 隋海晶[2] 谢秀海[2] 陈娟[1] 杨娟[1] 周媛[1] 

机构地区：[1]上海市浦东新区人民医院神经内科,201299 [2]上海市浦东新区人民医院放射科,201299

出　　处：《中华神经科杂志》2014年第7期455-459,共5页Chinese Journal of Neurology

基　　金：上海市浦东新区科技发展基金资助项目（PKJ2013-Y27）;上海市卫计委基金资助项目（20134179）;上海市浦东新区卫生系统重点学科建设基金资助项目（PWZx2014-15）;上海市浦东新区卫生系统领先人才培养基金及青年基金资助项目（PWR12010-02,PW2013B-8）;上海市浦东新区人民医院重点学科群基金资助项目（PRxkq2013-03）

摘　　要：目的 探讨磁共振成像（MRI）快速评价指导的觉醒型缺血性卒中（wake-up ischemic strokes,WUIS）患者静脉溶栓治疗的应用价值.方法 通过对WUIS患者和发病12 h内卒中患者行CT平扫初筛后排除颅内出血,行MR快速成像序列检查,筛选符合超急性期缺血性卒中患者,即DWI呈高信号,而T2WI或液体衰减反转恢复序列（FLAIR）无高信号改变及T1WI无低信号改变者,行重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗,对WUIS患者组和发病12 h卒中患者组进行临床、影像对照研究及90 d改良Rankin评分（modified Rankin scale,mRS）和生活质量Barthal指数（Barthal index,BI）比较.结果 463例被纳入本研究并进行MRI快速评价,其中261例（261/463,56.4％）通过MRI界定为超急性期缺血性卒中（WUIS组73例,73/121 =60.3％;12 h组188例,188/342=55.0％）.192例（WUIS组53例和12 h组139例）进行溶栓治疗,两组基线资料及溶栓后出血转化和病死率差异无统计学意义（P均＞0.05）,90 d mRS评分及生活质量BI差异无统计学意义（x2=1.296、1.473,P=0.538、0.489）.结论 对MRI快速评价指导的WUIS患者行静脉溶栓治疗是一种安全、有效的治疗方法.Objective To investigate the value of magnetic resonance imaging （MRI）-based intravenous thrombolysis in patients with wake-up ischemic strokes （WUIS）.Methods Patients presenting within 12 hours of acute stroke symptom onset and those with WUIS confirmed by CT,excluding intracranial hemorrhage,were encouraged to perform an emergent brain MRI scan to confirm the diagnosis of hyperacute ischemic stroke （hyper-intense in DWI without hyper-intense change in T2WI or fluid attenuated inversion recovery （FLAIR））.These patients then received intravenous thrombolytic therapy with recombinant tissue plasminogen activator （rt-PA）.All patients were divided into either stroke presenting within 12 hours or WUIS.The clinical outcomes were assessed by the modified Rankin scale （mRS） and the Barthal index （BI） at baseline and at 90 days after the thrombolysis therapy.Results Two hundred and sixty-one patients （261/563,56.4%） had confirmed diagnosis of hyperacute ischemic stroke （WUIS,n =73,73/121 =60.3% vs within 12 hours,n =188,188/342 =55.0%）.Altogether,192 patients （139 in within 12 hours group,and 53 in WUIS group） received intravenous thrombolytic therapy with rt-PA.No significant differences were found between the 2 groups at the baseline characteristics and at 90 days outcomes after the thrombolysis therapy（x2 =1.296 and 1.473,P =0.538 and 0.489,respectively）.Also no significant differences were found in the incidence rate of secondary hemorrhage （including both of asymptomatic and symptomatic） and mortality rate between the 2 groups.Conclusion MRI-based intravenous thrombolysis is safe and effective in the treatment of patients with hyperacute WUIS.

关 键 词：脑缺血 卒中 血栓溶解疗法 组织型纤溶酶原激活物 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]