轻型卒中:溶栓还是不溶栓?  

Thrombolysis or Not Thrombolysis for Minor Stroke?

作　　者：段春苗 熊云云 王拥军[1,2,5] DUAN Chunmiao;XIONG Yunyun;WANG Yongjun(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;China National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Department of Neurology,Beijing Daxing Hospital,Capital Medical University,Beijing 102600,China;Chinese Institute for Brain Research,Beijing 102206,China;Center for Stroke,Beijing Institute for Brain Disorders,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京100070 [2]国家神经系统疾病临床医学研究中心 [3]首都医科大学大兴教学医院 [4]北京脑科学与类脑研究中心 [5]北京脑重大疾病研究院脑卒中研究所

出　　处：《中国卒中杂志》2023年第1期107-113,共7页Chinese Journal of Stroke

基　　金：国家自然科学基金面上项目(82171272)。

摘　　要：轻型卒中的定义及诊断标准尚不统一,其是否都需要溶栓尚存在争议。轻型卒中在我国卒中患者中的比例有逐年增加的趋势,虽然有基于氯吡格雷用于急性非致残性脑血管病事件高危人群(clopidogrel in high-risk patients with acute non-disabling cerebrovascular events,CHANCE)系列研究抗血小板治疗的循证医学证据,但仍有30%的患者预后不良,由此带来的疾病负担仍然很重。当前指南对于发病4.5 h内的轻型致残性卒中推荐静脉溶栓治疗,而对于轻型非致残性卒中意见不一。近年的研究显示,对于轻型卒中合并大血管闭塞患者,早期包括静脉溶栓在内的积极再灌注治疗可能会给患者带来功能获益。本文对轻型卒中溶栓相关研究进行综述,期待未来有更多的设计严谨的大型试验来评估溶栓治疗在轻型卒中患者中的有效性和安全性。The definition and diagnostic criteria of minor stroke are not unified until now,and it is still controversial whether all patients with acute minor stroke need intravenous thrombolysis.The proportion of minor stroke patients in China has an increasing trend year by year.Although the CHANCE(clopidogrel in high-risk patients with acute non-disabling cerebrovascular events)trial and other studies have showed that antiplatelet therapy is effective for minor stroke,there are still approximately 30%of patients with poor functional outcomes and the burden of disease is very heavy.The current guidelines recommended intravenous alteplase administration within 4.5 hours for patients with disabling minor stroke but not for nondisabling minor stroke.Recent studies showed that reperfusion therapy including intravenous thrombolysis might be beneficial for patients with minor stroke and large vessel occlusion.This article reviewed the advances in thrombolytic therapy for minor stroke,to provide referenc e for clinical tre atment and relevant re search in minor stroke.

关 键 词：轻型卒中 溶栓治疗 阿替普酶 替奈普酶 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]