小剂量阿替普酶治疗高龄急性缺血性卒中患者的有效性和安全性  

Effectiveness and safety of low-dose alteplase in elderly patients with acute ischemic stroke

作　　者：刘勇[1] 杨杰 陈洪[2] 彭淼[2] 廖断修[2] 易兴阳[2] 蒋娟莉 

机构地区：[1]成都医学院第一附属医院神经内科,610500 [2]德阳市人民医院神经内科,618000

出　　处：《国际脑血管病杂志》2017年第9期809-812,共4页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨小剂量阿替普酶静脉溶栓治疗高龄急性缺血性卒中患者的有效性和安全性。方法前瞻性纳入高龄急性缺血性卒中患者（发病4.5 h内，年龄≥75岁），随机分为小剂量组（0.6 mg/kg）和标准剂量组（0.9 mg/kg）。主要转归指标为治疗后90 d改良Rankin量表（modified Rankin Scale, mRS）评分判定的转归良好（mRS评分0～2分）和转归不良（mRS评分〉2分）；次要转归指标为溶栓后24 h内颅内出血、有症状颅内出血和90 d内死亡。结果共纳入65例高龄急性缺血性卒中患者，其中小剂量组32例，标准剂量组33例，两组各项基线临床资料差异均无统计学意义。与治疗前比较，两组治疗后7 d、14 d和90 d mRS评分0～2分者所占比例均显著增高，但治疗后相同时间点两组间转归良好率差异均无统计学意义。此外，标准剂量组与小剂量组治疗后24 h内颅内出血（36.4%对25.0%；χ2＝0.985，P＝0.321）、有症状颅内出血（21.2%对9.4%；χ2＝1.749，P＝0.186）和治疗后90 d内死亡发生率（12.1%对6.3%；χ2＝0.151，P＝0.697）差异均无统计学意义。结论小剂量阿替普酶（0.6 mg/kg）静脉溶栓治疗高龄急性缺血性卒中患者的有效性和安全性与标准剂量相当。ObjectiveTo investigate the effectiveness and safety of intravenous thrombolytic therapy with low-dose alteplase for elderly patients with acute ischemic stroke.MethodsThe elderly patients with acute ischemic stroke were enrolled prospectively （onset within 4.5 h, aged ≥75 years）. They were randomly divided into either a low-dose group （0.6 mg/kg） or a standard-dose group （0.9 mg/kg）. The primary outcome was the modified Rankin Scale （mRS） score determined the good outcome （mRS score 0-2） and poor outcome （mRS score 〉2） at 90 d after treatment; the secondary outcome was intracranial hemorrhage and symptomatic intracranial hemorrhage at 24 h after thrombolysis, and death within 90 d.ResultsA total of 65 elderly patients with acute ischemic stroke were enrolled, including 32 in the low-dose group and 33 in the standard-dose group. There were no significant differences in all baseline clinical data between the two groups. Compared with before treatment, the proportions of patients with the mRS score 0-2 were significantly higher in both groups at 7 d, 14 d, and 90 d after treatment, but there were no significant differences in good outcome rate at the same time point after treatment between the two groups. In addition, there were no significant differences in intracranial hemorrhage （36.4% vs. 25.0%; χ2=0.985, P=0.321）, symptomatic intracerebral hemorrhage （21.2% vs. 9.4%; χ2=1.749, P=0.186） at 24 h after treatment, and incidence of death within 90 d after treatment （12.1% vs. 6.3%; χ2=0.151, P=0.697） between the two groups.ConclusionsThe effectiveness and safety of intravenous thrombolytic therapy with low-dose alteplase （0.6 mg/kg） in elderly patients with acute ischemic stroke is equivalent to the standard dose.

关 键 词：卒中 脑缺血 组织型纤溶酶原激活物 输注 静脉内 治疗结果 老年人 

分 类 号：R743.3[医药卫生—神经病学与精神病学]