轻型缺血性卒中患者静脉溶栓治疗分析

doi:10.3969/j.issn.1672-6731.2019.12.012

中国现代神经疾病杂志 ›› 2019, Vol. 19 ›› Issue (12): 975-980. doi: 10.3969/j.issn.1672-6731.2019.12.012

2 轻型缺血性卒中患者静脉溶栓治疗分析

宋兆慧¹, 童燕娜¹, 段洪连¹, 封靖¹, 孟繁花¹, 杜会山¹, 王佳伟²

1. 101149 首都医科大学附属北京潞河医院神经内科;
2. 100730 首都医科大学附属北京同仁医院神经内科

收稿日期:2019-11-07 出版日期:2019-12-25 发布日期:2020-01-03
通讯作者: 王佳伟,Email:wangjwcq@163.com
基金资助:
国家自然科学基金资助项目（项目编号：81271311）

Treatment analysis of intravenous thrombolysis in patients with mild ischemic stroke

SONG Zhao-hui¹, TONG Yan-na¹, DUAN Hong-lian¹, FENG Jing¹, MENG Fan-hua¹, DU Hui-shan¹, WANG Jia-wei²

1. Department of Neurology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China;
2. Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2019-11-07 Online:2019-12-25 Published:2020-01-03
Contact: WANG Jia-wei(Email:wangjwcq@163.com)
Supported by:
This study was supported by the National Natural Science Foundation of China (No. 81271311).

摘要/Abstract

摘要：

目的探讨重组组织型纤溶酶原激活物（rt-PA）治疗急性轻型缺血性卒中的有效性和安全性。方法纳入2017年11月至2018年10月发病4.50 h内入院的252例急性轻型缺血性卒中患者，分别行rt-PA静脉溶栓（静脉溶栓组，84例）、阿司匹林联合氯吡格雷双联抗血小板（双抗组，108例），以及阿司匹林或氯吡格雷抗血小板（单抗组，60例）治疗，治疗后24 h采用CT或MRI观察有无颅内出血，比较治疗前后血清超敏C-反应蛋白（hs-CRP）和红细胞沉降率（ESR）表达变化，并于入院后7 d、发病后21和90 d行改良Rankin量表评分判断预后。结果入院后7 d，不同治疗组患者血清hs-CRP（均P=0.000）和ESR（均P=0.000）水平降低，其中双抗组和单抗组血清hs-CRP（P=0.000，0.000）和ESR（P=0.000，0.010）高于静脉溶栓组；治疗后24 h，静脉溶栓组与抗血小板组颅内出血发生率差异无统计学意义[1.19%（1/84）对0（0/168）；χ²=2.008，P=0.366]。入院后7 d，静脉溶栓组预后良好率高于双抗组（P=0.043）和单抗组（P=0.012）；发病后21和90 d，静脉溶栓组预后良好率仅高于单抗组（P=0.021，0.037）。结论对于轻型缺血性卒中患者，尤其是症状轻微但可致残的患者应及时行rt-PA静脉溶栓，而因各种原因未能接受静脉溶栓治疗的患者则需在发病24小时内及时行阿司匹林联合氯吡格雷双联抗血小板治疗。

关键词: 卒中, 脑缺血, 组织型纤溶酶原激活物

Abstract:

Objective To analysis the safety and outcome of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute mild ischemic stroke. Methods From November 2017 to October 2018, 252 patients with acute mild ischemic stroke who were admitted into our hospital within 4.50 h after onset (84 patients in intravenous thrombolysis group, 108 patients in aspirin and clopidogrel group, and 60 patients in aspirin or clopidogrel group). The general condition, the level of high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation (ESR) were compared among 3 groups. The modified Rankin Scale (mRS) were evaluated on 7 d after admission or at earlier discharge, and 21 and 90 d. Symptomatic intracranial hemorrhage rates were compared among 3 groups. Results There were no significant difference in general clinical data, the initial level of hs-CRP and ESR between the intravenous thrombolytic group and the 2 non-thrombolysis groups. At 7 d after admission or earlier discharge, the descending range of hs-CRP and ESR in 3 groups were significant (P=0.000, for all); there were significant differences among the 3 groups (P=0.000, for all); pairwise comparison of 3 groups showed that the levels of hs-CRP and ESR in intravenous thrombolytic group at 7 d were significantly lower than aspirin and/or clopidogrel group (P=0.000, 0.000; P=0.000, 0.010). There was no significant difference in the rate of intracranial hemorrhage between thrombolytic group and other 2 groups at 24 h after treatment[1.19% (1/84) vs. 0 (0/168); χ²=2.008, P=0.366]. At 7 d after admission or earlier discharge, the intravenous thrombolytic group had better prognosis than aspirin and/or dopidogrel group (P=0.043, 0.012); At 21 and 90 d, the intravenous thrombolytic group had better prognosis than aspirin or clopidogrel group (P=0.021, 0.037); but compared with aspirin and clopidogrel group, there was no significant difference (P=0.070, 0.053). Conclusions Patients with mild ischemic stroke, especially that may induce disability should be treated with rt-PA intravenous thrombolysis timely. If it impossible by any causes, aspirin and clopidogrel should be given within 24 h after onset.

Key words: Stroke, Brain ischemia, Tissue plasminogen activator

宋兆慧, 童燕娜, 段洪连, 封靖, 孟繁花, 杜会山, 王佳伟. 轻型缺血性卒中患者静脉溶栓治疗分析[J]. 中国现代神经疾病杂志, 2019, 19(12): 975-980.

SONG Zhao-hui, TONG Yan-na, DUAN Hong-lian, FENG Jing, MENG Fan-hua, DU Hui-shan, WANG Jia-wei. Treatment analysis of intravenous thrombolysis in patients with mild ischemic stroke[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2019, 19(12): 975-980.

http://journal11.magtechjournal.com/cjcnn/CN/Y2019/V19/I12/975

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