摘要
目的:分析青海地区急性缺血性脑卒中(AIS)患者使用重组组织型纤溶酶原激活剂阿替普酶(rt-PA)静脉溶栓(IVT)后神经功能结局的影响因素。方法:分析发病4.5 h内接受IVT治疗的124例AIS患者,以入院时美国国立卫生研究院卒中量表(NIHSS)分为轻度卒中组(NIHSS评分≤5分)、中重度卒中组(NIHSS评分>5分)。3个月改良Rankin量表(mRS)评分>2分定义为神经功能结局不良。采用UBO detector软件,自动提取并标记脑白质高信号(WMH),自动分区定量得到WMH总体积、室周脑白质高信号(PVWMH)体积和深部脑白质高信号(DWMH)体积,采用二元多因素Logistic回归分析,以确定影响IVT后3个月神经功能结局的相关因素。结果:共纳入124例患者,中重度卒中患者71例(57.3%),59例(47.6%)患者发生神经功能结局不良,二元多因素Logistic回归分析显示:入院时NIHSS评分(OR=1.092,95%CI=1.004~1.188,P=0.039)、入院血糖值(OR=1.176,95%CI=1.038~1.331,P=0.011)可能是IVT后3个月神经功能结局不良的危险因素;小动脉闭塞型(SAO型)与大动脉粥样硬化型(LAA型)患者相比,SAO型在IVT后3个月可能更易获得良好的神经功能结局(OR=0.220,95%CI=0.068~0.706,P=0.011)。单因素分析中:DWMH为主组3个月mRS评分≤2分的占比高于PVWMH为主组,差异具有统计学意义(P<0.05)。结论:入院时NIHSS评分、入院时血糖值与IVT后3个月神经功能结局不良显著相关;以PVWMH为主的患者较DWMH为主的患者IVT后3个月的神经功能结局更差。
Objective:This paper is aimed to analyze the influencing factors of neurological outcome after intravenous thrombolysis(IVT)with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke(AIS)in Qinghai area.Methods:124 AIS patients receiving IVT treatment within 4.5 h of onset were analyzed,who were divided into mild stroke group(NIHSS score≤5 points)and moderate to severe stroke group(NIHSS score>5 points)according to the National Institutes of Health Stroke Scale(NIHSS)at admission.The 3-month modified Rankin scale(mRS)score>2 was defined as poor neurological outcome.UBO detector software was used to automatically extract and label white matter hyperintensities(WMH).The total volume of WMH,periventricular white matter hyperintensities(PVWMH)volume and deep white matter hyperintensities(DWMH)volume were quantitatively obtained by automatic partition.Binary multivariate Logistic regression analysis was used to determine the related factors affecting neurological outcome 3 months after IVT.Results:A total of 124 patients were included,among whom 71 patients showed with moderate to severe stroke(57.3%),59patients(47.6%)had adverse neurological outcomes.Binary multivariate Logistic regression analysis showed that NIHSS score at admission(OR=1.092,95%CI=1.004~1.188,P=0.039)and blood glucose at admission(OR=1.176,95%CI=1.038~1.331,P=0.011)may be risk factors for adverse neurological outcomes 3 months after IVT.However,compared with patients with large artery atherosclerosis(LAA),SAO type may be a protective factor for poor neurological outcome 3 months after IVT(OR=0.220,95%CI=0.068–0.706,P=0.011).In the single factor analysis,the proportion of mRS score≤2 in the DWMH group was higher than that in the PVWMH group with the statistically significant difference(P<0.05).Conclusion:NIHSS score at admission and blood glucose at admission were significantly associated with poor neurological outcome at 3 months after IVT.Patients with PVWMH had worse functional outcomes 3 months after IVT than patients with DWMH.
作者
张琳琳
周前鹏
徐琳祎
梁广逍
拜承萍
黄茜
田晔
郑西宁
石云科
马俊雯
Zhang Linlin;Zhou Qianpeng;Xu Linyi;Liang Guangxiao;Bai Chengping;Huang Qian;Tian Ye;Zheng Xining;Shi Yunke;Ma Junwen(Graduate School of Qinghai University,810001;Department of Neurology,Affiliated Hospital of Qinghai University,810001)
出处
《高原医学杂志》
CAS
2022年第1期1-10,共10页
Journal of High Altitude Medicine
基金
青海大学附属医院中青年科研基金一般项目(项目编号:ASRF-2021-YB-14)
关键词
急性缺血性脑卒中
阿替普酶
静脉溶栓
脑白质高信号
Acute ischemic stroke
Alteplase
Intravenous thrombolysis
White matter hyperintensity
