急性缺血性脑卒中发病6 h内MR-DWI阴性与阳性患者静脉溶栓的临床结局对比研究  

A Comparative Study of Intravenous Thrombolysis in MR-DWI-negative and DWI-positive Acute Ischemic Stroke Patients within 6 Hours of Onset

作　　者：万亚楠 张涛 王思思[1] 白青科[1] 沈健[1] 陆练军[1] 赵晓晖[1] 刘赞华 张健颖 WAN Ya-nan;ZHANG Tao;WANG Si-si;BAI Qingke;SHEN Jian;LU Lian-jun;ZHAO Xiao-hui;LIU Zan-hua;ZHANG Jian-ying(Shanghai Pudong New Area People's Hospital,Shanghai 201299,China)

机构地区：[1]上海市浦东新区人民医院,上海201299

出　　处：《中国临床神经科学》2023年第5期503-509,共7页Chinese Journal of Clinical Neurosciences

基　　金：上海市浦东新区卫健委面上项目(编号:PW2020A-74)。

摘　　要：目的对比分析急性缺血性脑卒中(AIS)发病6 h内头颅磁共振(MR)弥散加权成像(DWI)显示为阴性及阳性的患者使用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的临床结局和安全性。方法回顾性分析50例AIS患者住院治疗行rt-PA静脉溶栓,根据静脉溶栓前MR-DWI检查结果将AIS患者分为DWI阴性组18例和DWI阳性组32例,分析两组患者的人口学特征以及临床资料,包括入院至静脉溶栓时间(DNT)、发病至静脉溶栓时间(OTT),溶栓结束24 h内复查DWI,以发病后90 d的NIHSS评分和改良Rankin量表(mRS)评分作为预后的评估指标。结果两组患者年龄、性别、脑梗死病史、高血压病病史、糖尿病病史、房颤病史、吸烟史、饮酒史、DNT、OTT、颅内出血发生率和病死率比较差异均无统计学意义(均P>0.05);两组患者静脉溶栓前mRS评分及NIHSS评分均高于溶栓后90 d mRS评分及NIHSS评分(均P<0.05),DWI阴性组90 d mRS评分及NIHSS评分低于DWI阳性组(P<0.001,P=0.001)。结论发病6 h内DWI阴性及阳性的AIS患者均可在rt-PA静脉溶栓中获益,DWI阴性组的AIS患者rt-PA静脉溶栓后临床结局优于DWI阳性组,两组的出血转化率及病死率等安全性评价指标差异均无显著性。Aim To analyze comparatively of the clinical outcome and safety of rt-PA intravenous thrombolysis in acute ischemic stroke(AIS)patients with negative and positive results on DWI on magnetic resonance diffusion-weighted imaging(DWI)within 6 hours of onset.Methods Fifty patients with rt-PA intravenous thrombolysis hospitalized in our hospital were analyzed retrospectively.According to the results of the first cranial DWI in the emergency department,the patients were divided into a DWI negative group(18 cases)and a DWI positive group(32 cases).The demographic characteristics and clinical data of the two groups of patients were analyzed,including door to needle time(DNT),onset to treatment time(OTT),the imaging characteristics of DWI within 24 hours after thrombolysis.NIHSS scores and modified Rankin Scale(mRS)scores at 90 days after onset were used to evaluate the efficacy and prognostic indicators.Results There were no statistically significant differences in age,gender,diabetes history,atrial fibrillation history,smoking history,drinking history,DNT,OTT,intracranial hemorrhage incidence and mortality(P>0.05).The mRS score and NIHSS score before intravenous thrombolysis were higher than those at 90 days after thrombolysis in the two groups,and the differences were significant(P<0.05).The scores of 90 d mRS and NIHSS in DWI-negative group were lower than those in DWI-positive group(P<0.001,P=0.001).Conclusion Both DWI-negative and positive acute ischemic stroke patients within 6 hours of onset can benefit from rt-PA intravenous thrombolysis,but the clinical outcome of DWI-negative acute ischemic stroke patients after rt-PA intravenous thrombolysis is better than that of DWI-positive group.There was no difference in the safety of hemorrhagic transformation and mortality between the two groups.

关 键 词：磁共振弥散加权成像 阴性 急性缺血性脑卒中 静脉溶栓 

分 类 号：R743[医药卫生—神经病学与精神病学]