摘要：

目的: 探讨不同年龄阶段急性缺血性卒中患者阿替普酶静脉溶栓的短期疗效。方法: 纳入2018年3月至2021年11月安徽医科大学第一附属医院东城院区收治的70例急性缺血性卒中患者，根据年龄分为高龄组(≥ 70岁，38例)和非高龄组(< 70岁，32例)，均接受标准剂量阿替普酶静脉溶栓。分别于溶栓前及溶栓后2 h、24 h和7 d天采用美国国立卫生研究院卒中量表(NIHSS)评价神经功能，溶栓前和溶栓后7 d采用改良Rankin量表(mRS)评价预后，并记录溶栓后48 h和7 d内并发症发生率和病死率。结果: 不同年龄阶段患者溶栓前后NIHSS(F = 12.555，P = 0.001)和mRS(F = 13.927，P = 0.004)评分差异均有统计学意义，其中，NIHSS评分的年龄因素与时间因素存在交互作用(F = 3.847，P = 0.010)，mRS评分的年龄因素与时间因素无交互作用(F = 0.646，P = 0.424)。进一步两两比较，高龄组和非高龄组溶栓后2 h(t = 7.506，P = 0.000；t = 6.391，P = 0.000)、24 h(t = 9.982，P = 0.000；t = 6.391，P = 0.000)和7 d(t = 12.691，P = 0.000；t = 9.942，P = 0.000)NIHSS评分均低于溶栓前，溶栓后7 d NIHSS评分亦低于溶栓后2 h(t = 5.185，P = 0.000；t = 3.551，P = 0.003)和溶栓后24 h(t = 2.708，P = 0.043；t = 3.551，P = 0.003)；两组溶栓后7 d mRS评分亦低于溶栓前(P = 0.004)。溶栓后2 h、24 h和7 d，非高龄组与高龄组总有效(NIHSS评分改善率≥ 30%)率差异均无统计学意义[53.13%(17/32)对47.37%(18/38)，χ² = 0.461，P =0.794；75%(24/32)对55.26%(21/38)，χ² = 2.949，P = 0.229；81.25%(26/32)对65.79%(25/38)，χ² = 3.061，P = 0.216]。出院时非高龄组预后良好(mRS评分1 ~ 2分)率高于高龄组[87.50%(28/32)对57.89%(22/38)；χ² = 6.080，P = 0.014]。高龄组仅溶栓后48 h内皮肤、口腔以及牙龈出血发生率高于非高龄组[23.68%(9/38)对6.25%(2/32)；χ² = 3.986，P = 0.046]，两组均无死亡病例。结论: 不同年龄阶段的急性缺血性卒中患者予以阿替普酶静脉溶栓均可获益，尤以低龄患者获益更快、更显著，预后更好，不良反应更少。

关键词: 卒中, 脑缺血, 组织型纤溶酶原激活物, 年龄分布

Abstract:

Objective: To determine if rt-PA intravenous thrombolysis has distinct short-term effects on individuals of different ages with acute ischemic stroke. Methods: Seventy acute ischemic stroke patients admitted to Dongcheng Branch of The First Affiliated Hospital of Anhui Medical University from March 2018 to November 2021 were included, and were divided into an eld age group (≥ 70 years old, n = 38) and non-eld age group (< 70 years old, n = 32), and all received standard dose rt-PA intravenous thrombolysis at the time of admission and 2 h, 24 h and 7 d after thrombolysis, respectively. Neurological function was evaluated by National Institutes of Health Stroke Scale (NIHSS) at admission, and 2 h, 24 h and 7 d after thrombolysis. The prognosis was evaluated by modified Rankin Scale (mRS) before and 7 d after thrombolysis. Results: There were significant differences in NIHSS (F = 12.555, P = 0.001) and mRS (F = 13.927, P = 0.004) scores before and after thrombolysis in different age groups, in which there was a significant group × time interaction effect in NIHSS score in 2 groups (F = 3.847, P = 0.010), but no interaction for mRS score (F = 0.646, P = 0.424). The NIHSS score after thrombolysis at 2 h (t = 7.506, P = 0.000; t = 6.391, P = 0.000), 24 h (t = 9.982, P = 0.000; t = 6.391, P = 0.000) and 7 d (t = 12.691, P = 0.000; t = 9.942, P = 0.000) were lower than those before thrombolysis in 2 groups, the NIHSS score at 7 d after thrombolysis was also lower than that of 2 h after thrombolysis (t = 5.185, P = 0.000; t = 3.551, P = 0.003) and 24 h after thrombolysis (t = 2.708, P = 0.043; t = 3.551, P = 0.003). The mRS score at 7 d after thrombolysis was also lower than that of before thrombolysis in 2 groups (P = 0.004). At 2 h, 24 h and 7 d after thrombolysis, there was no statistically significant difference in the rate of total effect (NIHSS score improvement rate ≥ 30%) between 2 groups [53.13% (17/32) vs. 47.37% (18/38), χ² = 0.461, P = 0.794; 75% (24/32) vs. 55.26% (21/38), χ² = 2.949, P = 0.229; 81.25% (26/32) vs. 65.79% (25/38), χ² = 3.061, P = 0.216]. The rate of favorable prognosis (mRS score 1-2) at discharge was more significant in the non-eld age group than in the eld age group [87.50% (28/32) vs. 57.89% (22/38); χ² = 6.080, P = 0.014]. There were no fatalities in 2 groups, and the frequency of cutaneous, oral and gingival bleeding within 48 h after thrombolysis in eld age group was more common than in non- eld age group [23.68% (9/38) vs. 6.25% (2/32); χ² = 3.986, P = 0.046]. Conclusions: Patients with acute ischemic stroke in different age groups benefited from rt-PA intravenous thrombolysis, and the younger patients saw quicker, more noticeable improvements and fewer adverse effects.

Key words: Stroke, Brain ischemia, Tissue plasminogen activator, Age distribution