影响rt-PA治疗急性缺血性脑卒中患者临床预后的因素分析

目的：探讨影响重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗急性缺血性脑卒中患者预后的因素。方法：回顾性分析接受rt-PA静脉溶栓治疗的101例急性缺血性脑卒中患者按治疗后第90日改良Rankin量表(mRS)评分，分为预后良好组(mRS评分0-1分)及预后不良组(mRS评分2-6分)，比较两组患者的临床资料，采用单因素和Logistic回归分析影响预后的因素。结果：预后良好组(55例)与预后不良组(46例)相比，年龄较小(P=0.029)，既往有糖尿病病史者较少（P=0.012），溶栓前血糖较低(P=0.012)，溶栓前收缩压较低(P=0.003)，溶栓前美国国立卫生研究院卒中量表评分(NIHSS评分)低(P=0.002)，起病到治疗时间较短(P=0.044)，有脑白质疏松（Leukoaraiosis）者较少(P=0.005)。Logistic回归分析表明溶栓前NIHSS评分低、既往无糖尿病病史、溶栓前收缩压较低、溶栓前血糖较低、无脑白质疏松者与溶栓预后好显著相关。结论：溶栓前NIHSS评分低、既往无糖尿病病史者、溶栓前收缩压较低、溶栓前血糖较低、无脑白质疏松者的溶栓预后好。

Factors influencing the clinical outcome of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator

Objective To investigate factors that may influence the clinical outcome of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator. Methods This is a retrospective analysis. One hundred and one patients with acute ischemic stroke who received recombinant tissue plasminogen activator intravenous thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale(mRS) score,good outcome group: mRS score of 0-1; poor outcome group: mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and logistic regression. Result Of the 101 patients studied, patients in good outcome group (n=55) were significantly younger than patients in poor outcome group (n=46, P=0.029). Good outcome group had fewer patients with diabetic history(P=0.012),fewer patients with leukoaraiosis (P=0.005) and presented with lower blood glucose level (P=0.012), lower systolic blood pressure level (P=0.003), lower baseline NIHSS score (P=0.002) and shorter onset-to-treatment time(OTT) (P=0.044) than poor outcome group. Logistic regression analysis showed that absence of diabetic history, absence of leukoaraiosis,lower baseline NIHSS score and lower blood glucose level before thrombolysis were significantly associated with better outcome. Conclusion Patients with no history of diabetes, no leukoaraiosis ,low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolysis have a better outcome.