摘要
目的探讨老年急性脑梗死(AIS)患者不同分型静脉溶栓的出血转化和有效率情况,并进行疗效相关因素分析。方法AIS患者156例,依据静脉溶栓后早期神经功能是否改善分为症状有效组(97例)和无效组(59例),进行单因素和多因素分析,以明确影响溶栓早期神经功能恢复的相关危险因素。结果(1)不同病因的老年AIS患者采用阿替普酶溶栓后早期临床有效率及出血转化率有一定差异,其中病因不确定(UE)组及穿支动脉疾病(PAD)组有效率较高,出血转化率较低,而心源性卒中(CS)组早期有效率最低,出血转化率最高;(2)单因素分析显示早期神经功能有效组与无效组在中国缺血性卒中亚型(CISS)病因分型一大动脉粥样硬化型、合并感染、中重度脑白质高信号(WMH)方面差异比较有统计学意义(P<0.05);多因素回顾分析提示中重度WHM是老年患者早期神经功能恢复的独立危险因素(P<0.05)。结论不同病因的老年AIS患者采用静脉溶栓后早期临床有效率及出血转化率有一定差异,UE组及PAD组有效率较高,CS组出血转化率最高;中重度WMH是老年AIS患者静脉溶栓后影响早期神经功能恢复的独立危险因素。
Objective To evaluate clinical efficacy and hemorrhagic transformation rate(HTR)after intravenous thrombolysis in elderly acute ischemic stroke(AIS)patients caused by different subtype,and further to analyze the related factors.Methods A total of 156 elderly patient with AIS admitted to our hospital from January 2020 to October 2021 were selected,All patients received intravenous thrombolysis with alteplase within 4.5 hours of onset.The patients were divided into effective group(n=97)and ineffective group(n=59)according to the improvement of Early neurological function.To identify the risk factors of early neurological improvement after intravenous thrombolysis in patients with acute cerebral infarction,Univariate analysis and multivariate analysis were performed to compare the clinical data between the two groups,including general data,NIHSS score on admission,past medical history,laboratory tests.Results There are some differences in the early clinical effective rate and hemorrhagic transformation rate after intravenous thrombolysis with alteplase in elderly AIS patients with different Chinese ischemic stroke subclassification(CISS).Undetermined etiology(UE)group and penetrating artery disease(PAD)group had higher effective rate and lower hemorrhagic transformation rate,while cardiogenic disease(CS)group had the lowest early effective rate and the highest hemorrhagic transformation rate;@The proportion of large artery atherosclerosis subtype,prevalence of infection,moderate-severe white matter hyperintensity(WMH)in the ineffective group were higher than those in the effective group(P<0.05).Multivariate Logistic regression analysis showed that moderate-severe WMH were independent risk factors for early neurological improvement in patients with acute cerebral infarction undergoing intravenous thrombolysis(P<0.05).Conclusion There are some differences in the early clinical effective rate and hemorrhagic transformation rate after intravenous thrombolysis in elderly patients with AIS of different etiological subtype
作者
赵丽姣
杨松海
陈善鹏
张亚杰
王玉琳
崔志杰
Zhao Lijiao;Yang Songhai;Chen Shanpeng;Zhang Yajie;Wang Yulin;Cui Zhijie(Department of Neurology,the First Hospital of Qinhuangdao,Hebei 066000,China)
出处
《脑与神经疾病杂志》
CAS
2023年第3期180-185,共6页
Journal of Brain and Nervous Diseases
基金
秦皇岛市科学技术研究与发展计划项目(202101A154)。
关键词
急性脑梗死
静脉溶栓
临床疗效
脑白质高信号
Acute ischemic stroke
Intravenous thrombolysis
Clinical efficacy
White matter hyperintensity
