尿激酶和阿替普酶治疗超高龄急性缺血性脑卒中患者的效果  

Effectiveness of Urokinase and Alteplase in the treatment of super-aged patients with acute ischemic stroke

作　　者：周婷 廖娟 刘莉[4] 赵立波[1,2,3] 杨永红[1,2] 刘庆军 刘曙东[1,2] 杨德雨 ZHOU Ting;LIAO Juan;LIU Li;ZHAO Libo;YANG Yonghong;LIU Qingjun;LIU Shudong;YANG Deyu(Department of Neurology,Yongchuan Hospital of Chongqing Medical University,Chongqing,402160,China;Chongqing Key Laboratory of Cerebrovascular Disease Research,Chongqing,402160,China;Central Laboratory,Yongchuan Hospital of Chongqing Medical University,Chongqing,402160,China;Department of Health Management,Yongchuan Hospital of Chongqing Medical University,Chongqing,402160,China;Department of Internal Medicine,Changdu People’s Hospital,Tibet Region,Changdu,854000,China)

机构地区：[1]重庆医科大学附属永川医院神经内科,重庆402160 [2]脑血管病研究重庆市重点实验室,重庆402160 [3]重庆医科大学附属永川医院中心实验室,重庆402160 [4]重庆医科大学附属永川医院健康管理科,重庆402160 [5]西藏自治区昌都市人民医院内科,西藏昌都854000

出　　处：《中国医药导报》2021年第32期87-91,共5页China Medical Herald

基　　金：西藏自治区自然科学基金项目[Z2020ZR-ZY68(Z)];重庆市科卫联合医学科研项目(2019QNXM014)。

摘　　要：目的探讨尿激酶和阿替普酶治疗超高龄急性缺血性脑卒中(AIS)患者的效果。方法回顾性分析重庆医科大学附属永川医院2017年6月至2020年10月收治的106例超高龄AIS患者的临床资料。根据溶栓药物不同将其分为尿激酶组(44例)和阿替普酶组(62例)。使用倾向性评分匹配筛选出两组29对患者,其中尿激酶组含大血管闭塞(LVO)患者17例和非LVO患者12例,阿替普酶组含LVO患者20例和非LVO患者9例。比较两组的基线资料及观察指标[良好预后率、90 d改良Rankin量表(mRS)评分、美国国立卫生研究院卒中量表评分变化、死亡率、脑出血率、症状性脑出血率和颅外出血率]。结果匹配前,尿激酶组的发病至溶栓时间长于阿替普酶组,差异有统计学意义(P<0.05),其他基线资料和观察指标比较,差异无统计学意义(P>0.05)。匹配后,两组基线资料和观察指标比较,差异无统计学意义(P>0.05)。在LVO患者中尿激酶组良好预后率低于阿替普酶组,90 d mRS评分高于阿替普酶组,差异有统计学意义(P<0.05)。在非LVO患者中两组观察指标比较,差异无统计学意义(P>0.05)。结论尿激酶静脉溶栓治疗超高龄患者AIS相对安全有效。在超高龄非LVO卒中患者中,尿激酶与阿替普酶静脉溶栓的治疗效果相当,可作为阿替普酶的替代药物。Objective To explore the effectiveness of Urokinase and Alteplase in the treatment of super-aged patients with acute ischemic stroke(AIS).Methods The clinical data of 106 super-aged patients with AIS treated in Yongchuan Hospital of Chongqing Medical University from June 2017 to October 2020 was analyzed retrospectively.According to different thrombolytic drugs,they were divided into Urokinase group(44 cases)and Alteplase group(62 cases).Twenty-nine pairs of patients in two groups were screened by propensity score matching,including 17 patients with large vessel occlusion(LVO)and 12 patients with non-LVO in the Urokinase group,Alteplase group included 20 LVO patients and 9 non-LVO patients.The baseline characteristics and observation indexes(rate of favorable outcome,modified Rankin scale[mRS]score at 90 days,changes of the National Institutes of Health stroke scale score,death rate,rate of intracranial hemorrhage,rate of symptomatic intracranial hemorrhage,and rate of extracranial hemorrhage)were compared between the two groups.Results Before matching,the time from onset to thrombolysis in urokinase group was longer than that in Alteplase group,the difference was statistically significant(P<0.05),while there was no significant difference in other baseline data and observation indicators(P>0.05).After matching,there were no significant differences in baseline data and observation indicators between the two groups(P>0.05).In LVO patients,the rate of favorable outcome of Urokinase group was lower than that of alteplase group,and the mRS score at 90 days was higher than that of Alteplase group,with statistical significance(P<0.05).In non-LVO patients,there was no statistical significance between the two groups(P>0.05).Conclusion Intravenous Urokinase thrombolytic therapy for AIS in super-aged patients is relatively safe and effective.In super-aged patients with non-LVO stroke,the efficacy of Urokinase is comparable to that of Alteplase intravenous thrombolytic therapy,and it can be used as a substitute for Alteplase

关 键 词：超高龄 尿激酶 阿替普酶 大血管闭塞 静脉溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]