摘要
目的比较大脑中动脉（MCA）不同病变部位脑梗死患者行重组人组织型纤溶酶原激活剂（rt—PA）静脉溶栓的疗效，并分析影响预后的相关危险因素。方法选择自2013年1月至2016年12月在常州市第二人民医院神经内科住院且于发病后4．5h内行rt-PA静脉溶栓治疗的急性MCA脑梗死患者75例，依据MCA病变部位分为起始部病变组（Ⅰ型组）、主干远端病变组（Ⅱ型组）及分支病变组（Ⅲ型组）。以溶栓治疗后24h美国国立卫生研究院卒中量表（NIHSS）评分下降≥4分或降至0分为早期症状改善。比较3组患者间基线临床资料、入院时及溶栓治疗后24h NmSS评分、早期症状改善比例、出血转化比例、7d内死亡率及发病后90d改良Rankin量表（mRS）评分的差异．并进一步根据mRS评分分为预后良好组及预后不良组，采用多因素Logistic回归分析模型分析MCA不同病变部位对预后的影响。结果75例患者中Ⅰ型组22例（29．3％），Ⅱ型组16例（21.3％），Ⅲ型组37例（49.3％）。Ⅰ型组早期症状改善比例（6例，27．3％）明显低于Ⅱ型组（11例，68．8％1和Ⅲ型组（25例，67．5％），且症状性颅内出血发生率、7d内死亡率及发病后90dmRS评分均明显高于Ⅱ型组和Ⅲ型组，差异均有统计学意义（P〈0．05）。预后良好组（56例，74．7％）与预后不良组（19例，25.3％）在MCA病变部位、溶栓时间、入院时NIHSS评分及溶栓治疗后24h NIHSS评分方面比较差异均有统计学意义（P〈0．05）。多因素Logistic回归分析显示，MCA病变部位（OR=2．633，95％CI：1．119-6．197，P=0．027）、溶栓时间（OR=7．603，95％CI：1．561-37．043，P=0．012）、入院时NIHSS评分（OR=3．622，95％CI：1．068～12．285，P=0．039）是影响患者预后的危险因素。结论MCA不同病变部位脑梗死患者行静脉溶栓的疗效不同，且MCA病变部位、溶栓时间及发病时病
Objective To investigate the effect of intravenous recombinant tissue plasminogen activator （rt-PA） thrombolysis on patients with middle cerebral artery （MCA） infarction of different lesions and to analyze the influencing factors of clinical prognoses. Methods Seventy-five patients with acute infarction in the MCA territory were consecutively collected in our hospital from January 2013 to December 2016, and all patients underwent intravenous rt-PA thrombolysis within 4.5 h time window. The sites of MCA were classified into origin of the MCA （type Ⅰ）, MCA trunk distal to the lenticulostriate arteries （type Ⅱ） and branches of the MCA （type Ⅲ）. Early symptom improvement was defined as 24 h National Institutes of Health Stroke Scale （NIHSS） scores decreased≥4 or down to 0 after intravenous thrombolysis. Clinical data, NIHSS scores on admission and after intravenous thrombolysis, ratio of patients enjoying early symptom improvement, ratio of hemorrhagic transformation, mortality rate within 7 d of intravenous thrombolysis and modified Rankin scale （mRS） scores 90 d after intravenous thrombolysis were obtained and compared among the three groups. And according to mRS scores 90 d after intravenous thrombolysis, the patients were divided into good prognosis group and poor prognosis group; Logistic regression analysis was used to confirm the different prognoses of patients with MCA infarction of different lesions. Results Among the 75 enrolled patients, 22 （29.3%） were classified as type Ⅰ, 16 （21.3%） as type Ⅱ and 37 （49.3%） as type Ⅲ. Type Ⅰ patients （n=6, 27.3%） had significantly lower ratio of patients with early symptom improvement than type Ⅱ patients （n=11, 68.8%） and type Ⅲ patients （n=25, 67.5%,/9〈0.05）. Type Ⅰ patients had significantly higher ratio of symptomatic intracranial hemorrhage, higher mortality rate within 7 d of intravenous thrombolysis and higher mRS scores 90 d after intravenous thrombolysis than type Ⅱ patients and type
作者
刘艳艳
张敏
恽文伟
周先举
Liu Yanyan;Zhang Min;Yun Wenwei;Zhou Xianju(Department of Neurology, Changzhou Second People＇s Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2018年第2期154-160,共7页
Chinese Journal of Neuromedicine
基金
（1）国家自然科学基金面上项目（81471338）（2）常州市卫计委青年人才科技项目（QN201714）
关键词
脑梗死
大脑中动脉
病变部位
静脉溶栓
预后
Cerebral infarction
Middle cerebral artery
Lesion
Intravenous thrombolysis
Prognosis
