心房颤动对不同时间窗内急性缺血性脑卒中患者静脉溶栓结局的影响  

Influence of atrial fibrillation on intravenous thrombolysis of acute ischemic stroke patients within different time window

作　　者：娄一萍 张圣[1] 严慎强[1] 万锦平[1,3] 楼敏[1] 

机构地区：[1]浙江大学医学院附属第二医院神经内科,杭州310009 [2]浙江省绍兴市人民医院神经内科 [3]广西省贵港市人民医院神经内科

出　　处：《中华神经科杂志》2015年第8期661-667,共7页Chinese Journal of Neurology

基　　金：浙江省自然科学基金资助项目（LR12H09001）;浙江省科技厅重大项目（2013C03043-3）

摘　　要：目的 分析不同发病-溶栓时间窗内,合并心房颤动对急性缺血性脑卒中患者静脉溶栓治疗后出血转化和预后的影响.方法 回顾性分析2009年6月至2013年10月本科接受静脉重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗的急性缺血性脑卒中患者的资料,根据时间窗分为3组[≤3.0 h（A）、＞3.0h且≤4.5 h（B）和＞4.5 h（C）组,通过多因素分析3组患者心房颤动对溶栓后出血性梗死（HI）、脑实质出血（PH）及良好神经功能结局[改良Rankin量表评分（mRS）评分≤2分]的影响.结果 共345例患者纳入研究,其中A组101例（29.3％）,B组157例（45.5％）,C组87例（25.2％）.3组患者中,心房颤动分别占51/101 （50.5％）、59/157（37.6％）和35/87 （40.2％）,3组间差异无统计学意义（χ2=4.362,P=0.113）;HI型出血所占比例分别为17/101（16.8％）、35/157（22.3％）和18/87（20.7％）;PH型出血所占比例分别为5/101（5.0％）、16/157（10.2％）和9/87（10.3％）,出血转化的差异无统计学意义（χ2=4.278,P=0.370）;3组间良好神经功能结局差异无统计学意义[52/101（51.5％）,84/157（53.5％）,41/87（47.1％）,χ2=0.913,P=0.633].经多因素校正后发现：C组心房颤动可增加HI型出血风险（OR=1.208,95％ CI0.498～2.930,P=0.677）,并发现心房颤动增加B组PH型出血风险（OR=3.757,95％ CI1.133～12.457,P=0.030）.心房颤动对神经功能结局无独立影响.结论 合并心房颤动不影响急性缺血性脑卒中患者静脉溶栓后3个月的神经功能结局,但增加时间窗＞3.0h且≤4.5 h溶栓患者的PH型出血风险.Objective To assess the influence of atrial fibrillation on post-thrombolytic hemorrhagic transformation and functional prognosis in acute ischemic stroke patients within different time window.Methods We retrospectively reviewed the clinical and imaging data of patients of acute ischemic stroke with intravenous thrombolysis admitted from June 2009 to October 2013.According to onset-to-needle time,we divided patients into 3 groups and then assessed the effect of the comorbidity with atrial fibrillation on the occurrence of hemorrhagic transformation and favorable outcome （defined as modified Rankin Scale score≤2 at 90 days） after thrombolysis within different time window.Results A total of 345 patients were included in this study,among whom 101 （29.3%） were treated by intravenous thrombolysis within 3.0 h （≤3.0 h）,157（45.5%） 〉3.0 h and≤4.5 h,87（25.2%） over 4.5 h（〉4.5 h）.Atrial fibrillation was observed in 50.5% （51/101） patients in ≤3.0 h group,37.6% （59/157） in 〉3.0 h and≤4.5 h group and 40.2% （35/87） in 〉 4.5 h group （χ2 =4.362,P =0.113）.There were no statistically significant differences among these three groups about the rate of hemorrhagic transformation （hemorrhagic infarction：16.8% （17/101）,22.3% （35/157）,20.7% （18/87）,and parenchymal hematoma：5.0% （5/101）,10.2% （16/157）,10.3% （9/87）,χ2 =4.278,P =0.370） and favorable outcome （51.5% （52/101）,53.5% （84/ 157）,47.1% （41/87）,χ2 =0.913,P =0.633）.Multivariate analysis demonstrated that atrial fibrillation was associated with hemorrhagic infarction for patients in 〉 4.5 h group （OR =3.637,95% CI 1.101-12.013,P =0.034）,and the presence of atrial fibrillation independently predicted parenchymal hematoma for patients in 〉 3.0 h and ≤4.5 h group （OR =3.757,95% CI 1.133-12.457,P =0.030）.There was no significant association between atrial fibrillation and favorable outcome at 90 days.Conclusions The presence of atrial fibrillation is not associated w

关 键 词：心房颤动 脑缺血 卒中 血栓溶解疗法 组织型纤溶酶原激活物 时间 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]