糖化血红蛋白指导下的老年急性脑梗死伴血糖超标的阿替普酶静脉溶栓治疗  

Intravenous thrombolysis in acute cerebral infarction combined with hyperglycemia under guidance of glycosylated hemoglobin A_(lc)in the elderly

作　　者：谷亚伟 楚旭 赵岚[1] 王利军[1] 王洪新 Gu Yawei;Chu Xu;Zhao Lan;Wang Lijun;Wang Hongxin(Department of Neurology,Fourth Central Hospital Affiliated to Nankai University,Tianjin 300140,China;department of Internal Medicine,Xushui District People's Hospital of Baoding,Baoding 072500,China)

机构地区：[1]南开大学附属第四中心医院神经内科,天津300140 [2]保定市徐水区人民医院内科,072550

出　　处：《中华神经医学杂志》2021年第12期1248-1253,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨糖化血红蛋白(HbA1c)指导下阿替普酶(rt-PA)静脉溶栓治疗老年急性脑梗死伴血糖超标的安全性和有效性。方法回顾性纳入自2018年1月至2021年6月南开大学附属第四中心医院收治的262例老年急性脑梗死患者, 将入院血糖在2.8~22.2 mmol/L且接受rt-PA标准剂量静脉溶栓的72例患者纳入对照组;将入院血糖超过22.2 mmol/L、HbA1c检测值小于15.59%的患者纳入试验组, 并进一步根据患者是否接受rt-PA静脉溶栓及rt-PA用量将试验组患者分为保守治疗组(63例)、rt-PA小剂量组(0.6 mg/kg, 最大剂量为60 mg, 67例)和rt-PA标准剂量组(0.9 mg/kg, 最大剂量为90 mg, 60例)。参考NINDS临床试验制定的治疗效果评价标准评价治疗后24 h有效率、治疗后7 d短期预后;采用改良Rankin量表(mRS)评分评价患者治疗后90 d时远期预后。安全性评价指标主要包括治疗90 d内的颅内出血率及并发症发生率。结果 (1)治疗有效率及短期预后:治疗24 h后, 4组患者治疗有效率差异有统计学意义(P<0.05);其中对照组、rt-PA小剂量组和rt-PA标准剂量组有效率均高于保守组, 差异有统计学意义(P<0.05)。治疗7 d后, 4组患者预后良好率差异有统计学意义(P<0.05);其中对照组、rt-PA小剂量组和rt-PA标准剂量组预后良好率均高于保守组, 差异有统计学意义(P<0.05)。(2)治疗90 d时远期预后:对照组、保守治疗组、rt-PA小剂量组和rt-PA标准剂量组90 d预后良好例数分别为59(81.9%)、46(73.0%)、53(79.1%)和46(76.7%), 差异无统计学意义(P>0.05)。(3)治疗90 d内颅内出血及并发症发生率:4组患者治疗后90 d内颅内出血率差异有统计学意义(P<0.05);其中rt-PA标准剂量组、rt-PA小剂量组颅内出血率明显高于对照组及保守组, 且rt-PA标准剂量组的颅内出血率明显高于rt-PA小剂量组, 差异均有统计学意义(P<0.05)。对照组、保守治疗组、rt-PA小剂量组和rt-PA标准剂量组患者治疗后90 d�Objective To investigate the safety and efficacy of intravenous thrombolysis with recombinant human tissue-type plasminogen activator(rt-PA)in acute cerebral infarction combined with hyperglycemia under the guidance of glycosylated hemoglobin Alc(HbAlc)level in the elderly.Methods A retrospective study was performed.Two hundred and sixty-two elderly patients with acute cerebral infarction,admitted to our hospital from January 2018 to June 2021,were chosen in this study.Patients with admission blood glucose of 2.8-22.2 mmol/L and accepted intravenous thrombolysis with standard dose of rt-PA were enrolled into control group;patients with admission blood glucose over 22.2 mmol/L and HbAlc less than 15.59%were enrolled into experimental group.The patients in the experimental group were subdivided into conservative treatment group(n=63),rt-PA low-dose group(0.6 mg/kg,maximum dose 60 mg,n=61)and rt-PA standard dose group(0.9 mg/kg,maximum dose 90 mg,n=60)according to whether these patients received rt-PA intravenous thrombolysis or not and dosage of rt-PA.The response rate 24 h after treatment and short-term prognosis 7 d after treatment were evaluated by referring to the treatment effectiveness evaluation criteria developed by NINDS clinical trials.The long-term prognosis was evaluated by modified Rankin Scale(mRS)90 d after treatment.The safety evaluation indexes mainly included incidences of intracranial hemorrhage and complications within 90 d of treatment.Results(1)The response rate 24 h after treatment showed significant differences among the 4 groups(P<0.05):that in the control group,rt-PA low-dose group,and rt-PA standard dose group was significantly higher than that in the conservative treatment group(P<0.05);the good prognosis rate 7 d after treatment showed significant differences among the 4 groups:that in the control group,rt-PA low-dose group,and rt-PA standard dose group was significantly higher than that in the conservative treatment group(P<0.05).(2)Ninety d after treatment,59 patients(81.9%),46(73.0%)

关 键 词：急性脑梗死 糖尿病 阿替普酶 糖化血红蛋白 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R587.1[医药卫生—临床医学]