青年轻型急性缺血性卒中患者静脉溶栓治疗转归的预测因素  

Predictive factors of outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis

作　　者：王凯[1] 荣良群[1] 魏秀娥[1] 朱本亮[1] 王虎[1] 肖利杰[1] 

机构地区：[1]徐州医学院第二附属医院神经内科,221006

出　　处：《国际脑血管病杂志》2015年第8期584-587,共4页International Journal of Cerebrovascular Diseases

基　　金：徐州矿务集团有限公司科技项目（2014-61）

摘　　要：目的探讨青年轻型急性缺血性卒中静脉溶栓治疗转归的预测因素。方法回顾性纳入连续接受静脉溶栓治疗的青年（年龄18～45岁）轻型急性缺血性卒中患者。根据发病后90d时改良Rankin量表（modified Rankin Scale，mRS）评分分为转归不良组（≥2分）和转归良好组（0～1分），比较2组人口统计学和基线临床特征，采用多变量logistic回归分析确定青年轻型急性缺血性卒中静脉溶栓后转归不良的独立预测因素。结果共纳入57例接受静脉溶栓治疗的青年轻型急性缺血性卒中患者，其中转归良好41例（71．93％），转归不良16例（28．07％）。转归不良组与转归良好组间既往卒中或短暂性脑缺血发作（transient is chemic attack，TIA）史（25．00％对4．88％；P=0．046）、吸烟（56．25％对19．51％；P=0．010）、心房颤动（31．25％对7．32％；P=0．032）、糖尿病（62．50％对21．95％；,χ^2=8．515，P=0．004）、大动脉粥样硬化性卒中（68．75％对21．95％；χ^2=11．067，P=0．001）以及发病前接受抗血小板治疗（6．25％对34．15％；P=0．044）的患者构成比以及年龄（Z=2．396，P=0．020）差异有统计学意义。多变量logistic回归分析显示，年龄[优势比（odds ratio，OR）2．64，95％可信区间（confidence interval，CI）1．28～5．36；P=0．038]、既往卒中或TIA史（OR2．25，95％CI1．22～4．31；P=0．042）、心房颤动（OR5．12，95％CI1．58～19．23；P=0．032）、大动脉粥样硬化性卒中（OR5．89，95％CI1．78～19．92；P=0.002）是青年轻型急性缺血性卒中静脉溶栓治疗后转归不良的独立危险因素。结论年龄、既往卒中或TIA史、心房颤动以及大动脉粥样硬化性卒中是青年轻型急性缺血性卒中静脉溶栓后90d转归不良的独立预测因素。Objective To investigate the predictive factors of outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis. Methods Consecutive young patients with mild acute ischemic stroke （age 18- 45 years） treated with intravenous thrombolysis were enrolled retrospectively. According to the modified Rankin Scale （mRS） score at day 90 after onset, they were divided into either a poor outcome group （mRS ≥ 2） or a good outcome group （mRS 0- 1）. The demographic and baseline clinical characteristics were compared. Multivariate logistic regression analysis was used to identify the independent predictive factors of poor outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis. Results A total of 57 young patients with acute mild ischemic stroke treated with intravenous thrombolysis were enrolled, including 41 patients （71.93%） had good outcome and 16 （28.07%） had poor outcome. There were significant differences in the proportion of the patients with previous stroke or transient ischemic attack （TIA） （25.00% vs. 4. 88%; P= 0. 046）, smoking （56. 25% vs. 19.51% ; P = 0. 010）, atrial fibrillation （31.25% vs. 7.32% ; P = 0. 032）, diabetes （62. 50% vs. 21.95% ;χ^2 = 8. 515, P = 0. 004）, large artery atherosclerotic stroke （68.75% vs. 21.95% ; χ^2 =11. 067, P=0. 001）, and receiving antiphtelet therapy before symptom onset （6.25% vs. 34. 15%; P=0. 044） and the age （Z=2. 396, P=0. 020） between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that the age （odds ratio [ OR] 2.64, 95% confidence interval [CI] 1.28 -5.36; P=0. 038）, history of previous stroke or TIA （OR 2. 25, 95% CI 1.22 -4. 31; P =0. 042）, atrial fibrillation （OR 5.12, 95% CI 1.58 - 19. 23; P =0. 032）, and large artery atherosclerotic stroke （OR 5.89, 95% CI 1.78 - 19.92; P = 0. 002） were the independent risk factors for poor outcome after mild acute ischemic stroke thrombo

关 键 词：卒中 脑缺血 血栓溶解疗法 组织型纤溶酶原激活物 疾病严重程度指数 治疗结果 危险因素 年轻人 

分 类 号：R743.3[医药卫生—神经病学与精神病学]