心源性卒中患者静脉溶栓后对血管再通与组织再灌注及临床结局的影响
发布时间：2019-03-15 14:34
【摘要】：目的 探讨心源性卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后血管再通、缺血组织再灌注及3个月预后的神经功能结局的影响。 方法 回顾性分析浙江大学医学院附属第二医院神经内科2009年6月至2014年1月期间接受rt-PA静脉溶栓治疗,并在溶栓前后均接受多模式头颅磁共振(MRP)扫描的缺血性卒中患者临床及影像学资料。根据动脉闭塞评分(Arterial occlusive lesion scale, AOL)评价溶栓后血管再通情况。以脑血流达峰时间(Time to peak, Tmax)6s区域为组织低灌注区,将溶栓后24h这一区域缩减60%定义为溶栓后再灌注。按中国缺血性卒中亚型分类(Chinese ischemic stroke subclassification, CISS)分型将入组患者分为心源性卒中与非心源性卒中组,比较两组患者的临床特点和溶栓后血管再通、组织再灌注及3个月临床预后的差异。 结果 共76例患者纳入分析,心源性卒中40例(52.6%),其中房颤者37例(92.5%)。心源性卒中与非心源性卒中组相比,既往吸烟史者较少(17.5%vs.50%,χ2=9.066,P=0.003),同型半胱氨酸水平较低(13.4±5.9vs.19.0±11.9umol/L, t=2.613,P=0.016),但两组间溶栓后血管再通率、再灌注率及3月床预后无统计学差异。心源性卒中与非心源性卒中两组出血转化无明显差异(34.6%vs.38.7%, x2=0.102,P=0.750)。影响血管再通的独立因素为：大动脉粥样硬化性卒中(OR=0.292,95%CI=0.088～0.966, P=0.044);溶栓后组织再灌注的独立影响因素为女性(OR=0.081,95%CI=0.013～0.514, P=0.008)和血管再通(OR=29.39,95%CI=4.534～190.521, P=0.000)。影响缺血性卒中3个月预后的独立因素为女性(OR=0.138,95%CI=0.020～0.944, P=0.044),基线NIHSS (OR=0.610,95%CI=0.459～0.812, P=0.001)及血管再通(OR=47.567,95%CI=3.904～579.546, P=0.002).影响心源性卒中3月后预后因素为基线NIHSS (OR=0.7198,95%CI=0.569～0.909, P=0.006)。 结论 心源性卒中并不影响静脉溶栓后血管再通和组织再灌注。心源性卒中患者的3月临床结局不劣于非心源性卒中。
[Abstract]:Objective to investigate the effects of intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) on vascular recanalization, ischemic tissue reperfusion and 3-month prognosis in patients with cardiogenic apoplexy. Methods from June 2009 to January 2014, the Department of Neurology of the second affiliated Hospital of Zhejiang University Medical College was treated with rt-PA intravenous thrombolytic therapy. The clinical and imaging data of ischemic stroke patients underwent multi-mode magnetic resonance imaging (MRP) before and after thrombolysis. The recanalization of blood vessels after thrombolysis was evaluated according to the arterial occlusion score (Arterial occlusive lesion scale, AOL). The peak time of cerebral blood flow (Time to peak, Tmax) 6s) was taken as tissue low perfusion area, and the area reduced by 60% at 24h after thrombolysis was defined as reperfusion after thrombolysis. The patients were divided into cardiac stroke group and non-cardiogenic stroke group according to the (Chinese ischemic stroke subclassification, CISS) classification of Chinese ischemic stroke subtype. The clinical characteristics and vascular recanalization after thrombolysis were compared between the two groups. The difference of clinical prognosis between tissue reperfusion and 3 months. Results among 76 patients, 40 (52.6%) were cardiogenic apoplexy, and 37 (92.5%) were atrial fibrillation. Compared with the non-cardiogenic stroke group, the previous smoking history was lower (17.5% vs. 50%, 蠂 2 = 9.06 6, P < 0.003), and homocysteine level was lower (13.4 卤5.9vs.19.0 卤11.9umol / L, t = 2.613, P = 0.016), compared with the non-cardiogenic stroke group (17.5% vs. 50%, 蠂 2 = 9.06 6, P = 0.003). However, there was no significant difference in vascular recanalization rate, reperfusion rate and 3-month bed prognosis between the two groups. There was no significant difference between cardiac stroke group and non-cardiogenic stroke group (34.6% vs. 38.7%, x2 / 0.102, P = 0.750). The independent factors influencing vascular recanalization were as follows: great atherosclerotic stroke (OR=0.292,95%CI=0.088~0.966, P0. 044); The independent influencing factors of tissue reperfusion after thrombolysis were female (OR=0.081,95%CI=0.013~0.514, P0. 008) and vascular recanalization (OR=29.39,95%CI=4.534~190.521, P0. 000). The independent factors influencing the 3-month prognosis of ischemic stroke were female (OR=0.138,95%CI=0.020~0.944, P0. 044), baseline NIHSS (OR=0.610,95%CI=0.459~0.812, P0. 001) and recanalization (OR=47.567,95%CI=3.904~579.546,). (P = 0.002). Baseline NIHSS (OR=0.7198,95%CI=0.569~0.909, P = 0.006) was the prognostic factor after 3 months of cardiogenic stroke. Conclusion Cardiogenic stroke does not affect vascular recanalization and tissue reperfusion after intravenous thrombolysis. The 3-month clinical outcome of patients with cardiogenic stroke was no worse than that of non-cardiogenic stroke.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
[Abstract]:Objective to investigate the effects of intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) on vascular recanalization, ischemic tissue reperfusion and 3-month prognosis in patients with cardiogenic apoplexy. Methods from June 2009 to January 2014, the Department of Neurology of the second affiliated Hospital of Zhejiang University Medical College was treated with rt-PA intravenous thrombolytic therapy. The clinical and imaging data of ischemic stroke patients underwent multi-mode magnetic resonance imaging (MRP) before and after thrombolysis. The recanalization of blood vessels after thrombolysis was evaluated according to the arterial occlusion score (Arterial occlusive lesion scale, AOL). The peak time of cerebral blood flow (Time to peak, Tmax) 6s) was taken as tissue low perfusion area, and the area reduced by 60% at 24h after thrombolysis was defined as reperfusion after thrombolysis. The patients were divided into cardiac stroke group and non-cardiogenic stroke group according to the (Chinese ischemic stroke subclassification, CISS) classification of Chinese ischemic stroke subtype. The clinical characteristics and vascular recanalization after thrombolysis were compared between the two groups. The difference of clinical prognosis between tissue reperfusion and 3 months. Results among 76 patients, 40 (52.6%) were cardiogenic apoplexy, and 37 (92.5%) were atrial fibrillation. Compared with the non-cardiogenic stroke group, the previous smoking history was lower (17.5% vs. 50%, 蠂 2 = 9.06 6, P < 0.003), and homocysteine level was lower (13.4 卤5.9vs.19.0 卤11.9umol / L, t = 2.613, P = 0.016), compared with the non-cardiogenic stroke group (17.5% vs. 50%, 蠂 2 = 9.06 6, P = 0.003). However, there was no significant difference in vascular recanalization rate, reperfusion rate and 3-month bed prognosis between the two groups. There was no significant difference between cardiac stroke group and non-cardiogenic stroke group (34.6% vs. 38.7%, x2 / 0.102, P = 0.750). The independent factors influencing vascular recanalization were as follows: great atherosclerotic stroke (OR=0.292,95%CI=0.088~0.966, P0. 044); The independent influencing factors of tissue reperfusion after thrombolysis were female (OR=0.081,95%CI=0.013~0.514, P0. 008) and vascular recanalization (OR=29.39,95%CI=4.534~190.521, P0. 000). The independent factors influencing the 3-month prognosis of ischemic stroke were female (OR=0.138,95%CI=0.020~0.944, P0. 044), baseline NIHSS (OR=0.610,95%CI=0.459~0.812, P0. 001) and recanalization (OR=47.567,95%CI=3.904~579.546,). (P = 0.002). Baseline NIHSS (OR=0.7198,95%CI=0.569~0.909, P = 0.006) was the prognostic factor after 3 months of cardiogenic stroke. Conclusion Cardiogenic stroke does not affect vascular recanalization and tissue reperfusion after intravenous thrombolysis. The 3-month clinical outcome of patients with cardiogenic stroke was no worse than that of non-cardiogenic stroke.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
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