合并脑微出血急性缺血性脑卒中患者静脉溶栓治疗的风险评估及安全性研究  

Safety of intravenous thrombolytic therapy with alteplase in patients with acute cerebral ischemic stroke complicated with cerebral microbleeds

作　　者：张玉显 张佩兰[2] ZHANG Yuxian;ZHANG Peilan(Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin 300070, Chin)

机构地区：[1]天津医科大学,天津300070 [2]天津市环湖医院神经内科四病区,天津300350

出　　处：《中风与神经疾病杂志》2018年第4期314-316,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的研究脑微出血是否增加急性缺血性脑卒中静脉溶栓治疗脑出血的风险。方法对2015年7月-2016年7月期间天津市环湖医院神经内科四病区发病4.5 h内接受阿替普酶(recombinant tissue plasminogen activator,rtPA)急性缺血性脑卒中患者206例进行回顾性研究:发病4.5 h内接受阿替普酶静脉溶栓治疗的206例患者,溶栓前根据头部MRI检查分为微出血组89例,无微出血组117例;主要观察指标是溶栓后住院期间症状性及非症状性脑出血发生率和3个月良好预后率,次要观察指标是3个月生存率。结果含铁血黄素沉积组症状性脑出血共2例(2.2%),与无含铁血黄素沉积组3例(2.6%)相比,两组间差异无统计学意义(P=0.874)。含铁血黄素沉积组非症状性脑出血共4例(4.5%),与无含铁血黄素沉积组2例(1.7%)相比,两组间差异无统计学意义。3个月神经功能获得良好预后,含铁血黄素组共计41例(46.1%),无含铁血黄素组62例(52.9%),两组间差异无统计学意义(P=0.325)。含铁血黄素沉积组3个月生存率92.1%,无含铁血黄素沉积组为95.7%,两组间差异无统计学意义。结论急性缺血性脑卒中患者合并脑微出血(CMB)与静脉溶栓治疗后出血性转化无显著相关。Objective To study whether previous cerebral micro-hemorrhage increases the risk of cerebral hemorrhage by intravenous thrombolysis in acute ischemic stroke. Methods The cases of acute ischemic stroke patients receiving recombinant tissue plasminogen activator（ rtPA） within 4. 5 hours after the onset of the fourth ward of neurology in Tianjin Huanhu Hospital from July 2015 to July 2016 were retrospectively studied： 206 patients receiving intravenous alteplase within 4. 5 hours of onset were divided into micro-bleeding group（ n = 89） and non-micro-bleeding group（ n = 117） before the thrombolysis. The main observation index was the incidence of symptomatic and non-symptomatic intracerebral hemorrhage during hospitalization after thrombolysis and good prognosis for 3 months,the secondary outcome measure was 3 month survival. Results There were no significant differences between the two groups in the incidence of symptomatic intracerebral hemorrhage in the hemosiderin group（ 2. 2%） and in the non-hemosiderin deposition group（ 2. 6%）（ P = 0. 874）. There were 4 non-symptomatic intracerebral hemorrhages in the hemosiderin group（ 4. 5%） compared with 2 in the hemosiderinfree group（ 1. 7%）,with no significant difference between the two groups. There was a good prognosis at 3 months in neurological function,including 41 cases（ 46. 1%） in hemosiderin group and 62 cases（ 52. 9%） in hemosiderin-free group.There was no significant difference between the two groups（ P = 0. 325）. The 3 month survival rate of hemosiderin-treated group was 92. 1%,and that of hemosiderin-free group was 95. 7%. There was no significant difference between the two groups. Conclusion There is no significant correlation between CMBs in patients with acute ischemic stroke and hemorrhagic transformation after intravenous thrombolysis.

关 键 词：急性缺血性脑卒中 脑微出血 临床预后 出血性转化 静脉溶栓 

分 类 号：R743.34[医药卫生—神经病学与精神病学]