静脉溶栓治疗急性轻型非致残性缺血性脑卒中有效性和安全性的临床观察:一项单中心回顾性观察研究  

Clinical observation on the efficacy and safety of intravenous thrombolysis in the treatment of acute mild non-disabling ischemic stroke:a single-center retrospective observational study

作　　者：张萌 马咏馨 贾琼 张东威[1] 张昕红[1] 徐耀铭 Zhang Meng;Ma Yongxin;Jia Qiong;Zhang Dongwei;Zhang Xinhong;Xu Yaoming(Department of Neurology,Affiliated Hospital of Inner Mongolia University for Nationalities,Tongliao 028000,Inner Mongolia Autonomus Region,China;Tongliao Clinical Medical College,Inner Mongolia Medical University,Tongliao 028000,Inner Mongolia Autonomus Region,China)

机构地区：[1]内蒙古民族大学附属医院神经内科,内蒙古通辽028000 [2]内蒙古医科大学通辽临床医学院,内蒙古通辽028000

出　　处：《首都医科大学学报》2025年第1期56-62,共7页Journal of Capital Medical University

基　　金：内蒙古自治区卫生健康科技计划项目(202201571);内蒙古自治区慢性病中(蒙)西医结合基础研究与转化创新中心开放课题(MDK2023001)。

摘　　要：目的探讨静脉溶栓与双抗治疗急性轻型非致残性缺血性脑卒中的临床疗效及安全性。方法回顾性连续纳入2022年1月至2024年3月发病6 h内的急性轻型非致残性缺血性脑卒中患者138例[美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤5]为研究对象,根据是否接受静脉溶栓分为静脉溶栓组(66例)和双抗组(72例),采用倾向性评分匹配法将两组患者按照1∶1进行匹配,匹配后静脉溶栓组(44例)和双抗组(44例)。收集患者的人口学资料、临床资料、临床预后指标及不良事件。主要结局定义为发病后90 d良好功能结局[改良Rankin量表(modified Rankin Scale,mRS)评分0~2分]、发病后90 d mRS评分。次要结局为发病后24 h、72 h、7 d NIHSS评分,早期神经功能恶化比例,发病90 d内颅内出血及系统性出血事件及发病90 d内死亡。结果①匹配前静脉溶栓组年龄、入院时mRS评分均低于双抗组,差异均有统计学意义(均P<0.05)。匹配后两组患者在年龄、性别、高血压病、糖尿病、冠状动脉粥样硬化性心脏病、房颤、高低密度脂蛋白胆固醇血症、高同型半胱氨酸血症、既往脑卒中病史、吸烟史、入院时NIHSS评分、入院时mRS评分、梗死部位、TOAST分型等资料的差异均无统计学意义(均P>0.05);②静脉溶栓组与双抗组患者发病后90 d良好功能结局患者比例和发病后90 d mRS评分差异无统计学意义[88.6%(39/44)vs 93.2%(41/44),P=0.458、P=0.308];③静脉溶栓组发病后24 h、72 h中位NIHSS评分明显低于双抗组,差异有统计学意义[1 vs 2.5、1 vs 2,P=0.018、0.043],其余有效性结局和安全性结局差异均无统计学意义。结论静脉溶栓治疗能够为急性轻型非致残性缺血性脑卒中患者带来显著的短期获益,有助于缩短恢复至良好神经功能结局的时间,且不增加出血风险和病死率。然而,在发病后90 d良好功能结局方面,其效果与双�Objective To explore the clinical efficacy and safety of intravenous thrombolysis and dual antiplatelet therapy in the treatment of acute mild non-disabling ischemic stroke.Methods A retrospective cohort study was conducted,including 138 patients with acute mild non-disabling ischemic stroke[National Institutes of Health Stroke Scale(NIHSS)score≤5]from January 2022 to March 2024,within 6 h of onset.Patients were divided into an intravenous thrombolysis group(66 cases)and a dual antiplatelet group(72 cases).Propensity score matching was used to match patients 1∶1,resulting in 44 patients in each group after matching.Demographic data,clinical data,clinical outcome indicators,and adverse events were collected.The primary outcome was defined as a good functional outcome[modified Rankin Scale(mRS)score 0-2]at 90 d post-onset.Secondary outcomes included NIHSS scores at 24 h,72 h,and 7 d post-onset;the proportion of early neurological deterioration;intracranial and systemic hemorrhagic events within 90 d post-onset;and death within 90 d.Results①Before matching,the intravenous thrombolysis group had a lower age and admission mRS score than that of the dual antiplatelet group,with statistically significant differences(all P<0.05).After matching,there were no statistically significant differences between the two groups in terms of age,gender,hypertension,diabetes,cardiac disease,atrial fibrillation,hyper low density lipoprotein-cholesterol(LDL-C),hyperhomocysteinemia,prior stroke,prior smoking,admission NIHSS score,admission mRS score,location of stroke and TOAST classification(all P>0.05);②There was no statistically significant difference in the proportion of patients with a good functional outcome at 90 d post-onset and the mRS score at 90 d between the intravenous thrombolysis group and the dual antiplatelet group[88.6%(39/44)vs 93.2%(41/44),P=0.458,P=0.308];③The intravenous thrombolysis group had significantly lower median NIHSS scores at 24 h and 72 h post-onset compared to the dual antiplatelet group,with s

关 键 词：静脉溶栓 双联抗血小板治疗 急性轻型非致残性缺血性脑卒中 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]