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中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 338 -341. doi: 10.11817/j.issn.1673-9248.2022.05.009

临床研究

急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓预后相关危险因素分析
张晓丽1, 韩鑫1, 韩坤锜1, 李姗姗1, 刘相静1, 徐东成1, 牟磊1,†()   
  1. 1. 276500　山东日照，日照市中医医院神经内科
  • 收稿日期:2021-12-24 出版日期:2022-10-01
  • 通信作者: 牟磊
  • 基金资助:
    山东省中医药管理局-山东省2019-2020年度中医药科技发展计划项目(2019-0807); 济宁医学院青年教师扶持基金(JYFC2018FKJ148); 山东省医药卫生科技发展计划项目(2019WS165)

Risk factors related to prognosis of intravenous thrombolysis with alteplase in patients with acute cerebral infarction

Xiaoli Zhang1, Xin Han1, Kunqi Han1, Shanshan Li1, Xiangjing Liu1, Dongcheng Xu1, Lei Mou1,†()   

  1. 1. Department of Neurology, Rizhao Hospital of Traditional Chinese Medicine, Rizhao 276500, China
  • Received:2021-12-24 Published:2022-10-01
  • Corresponding author: Lei Mou
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张晓丽, 韩鑫, 韩坤锜, 李姗姗, 刘相静, 徐东成, 牟磊. 急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓预后相关危险因素分析[J]. 中华脑血管病杂志(电子版), 2022, 16(05): 338-341.

Xiaoli Zhang, Xin Han, Kunqi Han, Shanshan Li, Xiangjing Liu, Dongcheng Xu, Lei Mou. Risk factors related to prognosis of intravenous thrombolysis with alteplase in patients with acute cerebral infarction[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(05): 338-341.

目的

急性脑梗死患者重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓预后相关危险因素分析。

方法

回顾性选取2018年10月至2020年10月日照市中医医院收治的138例急性缺血性脑卒中患者为研究对象，根据改良Rankin量表评分将患者分为预后良好组和预后不良组。收集患者年龄、性别、吸烟、入院到静脉溶栓开始时间（DNT）、既往高血压、既往糖尿病、高脂血症、心房颤动、冠状动脉粥样硬化性心脏病（冠心病）、治疗前美国国立卫生研究院卒中量表（NIHSS）评分、卒中和短暂性脑缺血发作既往史等信息，采用t检验、秩和检验或χ2检验比较上述资料2组间的差异，采用Logistic回归分析溶栓预后不良的影响因素。

结果

138例患者中75例预后良好，63例预后不良。影响患者预后的单因素分析结果显示，2组患者年龄、性别、吸烟、DNT、既往糖尿病、高脂血症、心房颤动、冠心病、卒中和短暂性脑缺血发作既往史比较，差异均无统计学意义（P均＞0.05）；预后良好组患者治疗前NIHSS评分、既往高血压患者比例低于预后不良组[2.0（0，4.5）分 vs 4.0（2.0，6.0）分；32/75 vs 39/63]，差异具有统计学意义（Z=-3.28，P=0.001；χ2=5.45，P=0.024）。Logistic多因素回归分析显示，治疗前NIHSS评分（OR=2.191，95%CI：1.058~4.537）、既往高血压（OR=1.647，95%CI：0.811~3.345）均是影响患者预后的独立危险因素。

结论

治疗前NIHSS评分、既往高血压病对患者的预后有影响，且是影响患者不良预后的独立危险因素。

关键词: 急性脑梗死, 重组组织型纤溶酶原激活剂, 静脉溶栓, 危险因素
Objective

To analyze the prognostic risk factors of intravenous thrombolysis with alteplase in patients with acute cerebral infarction.

Methods

138 patients with acute ischemic stroke, admitted to Rizhao Hospital of Traditional Chinese Medicine from October 2018 to October 2020, were retrospectively included. The patients were divided into good prognosis group and poor prognosis group according to the modified Rankin scale. The age, sex, smoking, time from admission to start of intravenous thrombolysis (DNT), previous hypertension, previous diabetes, hyperlipidemia, atrial fibrillation, coronary atherosclerotic heart disease (CAD), National Institute of Health stroke scale (NIHSS) before treatment, history of stroke and transient ischemic attack, and other information were collected. The difference between the two groups was compared by by t-test, rank sum test or χ2, and the factors of prognosis were analyzed by logistic regression.

Results

Among 138 patients, 75 had a good prognosis and 63 had a poor prognosis. The results of patients' prognosis by univariate analysis showed that there was no significant difference between the two groups in terms of age, gender, smoking, DNT, previous diabetes, hyperlipidemia, atrial fibrillation, CAD, and previous history of stroke and transient ischemic attack (P＞0.05); The NIHSS and the proportion of patients with previous hypertension in the two groups before treatment were compared [2.0 (0, 4.5) points vs 4.0 (2.0, 6.0) points; 32/75 vs 39/63], and the difference was statistically significant (Z=-3.28, P=0.001; χ2=5.45, P=0.024). Logistic regression analysis showed that NIHSS (OR=2.191, 95%CI: 1.058-4.537) and previous hypertension (OR=1.647, 95%CI: 0.811-3.345) before treatment were independent risk factors affecting the prognosis of patients.

Conclusion

NIHSS before treatment and previous hypertension impact the prognosis of patients and are independent risk factors for poor prognosis.

Key words: Acute ischemic stroke, Recombinant tissue plasminogen activator, Intravenous thrombolysis, Risk factors
表1 急性缺血性脑卒中患者静脉溶栓预后良好组和预后不良组临床资料比较
组别 例数 年龄（岁，
x¯
±s）		 女/男（例） 既往高血压（例） 吸烟（例） NIHSS评分[分，M（QR）] 糖尿病（例） 心房颤动（例） DNT（min，
x¯
±s）		 冠心病（例） 卒中和TIA病史（例） 高脂血症（例）
预后良好组 75 60.27±9.55 26/49 32 39 2.0（0，4.5） 32 31 107.23±41.78 12 39 41
预后不良组 63 62.57±10.24 30/33 39 25 4.0（2.0，6.0） 22 21 123.73±55.85 13 39 43
统计值 t=-1.79 χ2=2.38 χ2=5.45 χ2=2.09 Z=-3.28 χ2=0.86 χ2=0.93 t=-1.47 χ2=0.45 χ2=1.37 χ2=2.65
P值 0.073 0.122 0.024 0.148 0.001 0.353 0.334 0.140 0.504 0.242 0.103
表 2 急性缺血性脑卒中患者溶栓不良预后的多因素Logistic回归分析
因素 β值 Sb值 Wald χ2值 P值 OR值 95%CI
既往高血压 0.499 0.361 1.905 0.020 1.647 0.811~3.345
NIHSS评分 0.784 0.372 4.456 0.035 2.191 1.058~4.537
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