心房颤动对静脉溶栓治疗急性缺血性卒中转归的影响

目的 探讨心房颤动(atrial fibrillation,AF)对急性缺血性卒中患者静脉溶栓后临床转归和出血性转化(hemorrhagic transformation,HT)的影响.方法 回顾性纳入接受静脉重组组织型纤溶酶原激活剂溶栓治疗的急性缺血性卒中患者.90 d时改良Rankin量表评分0～2分定义为转归良好.采用多变量logistic回归分析确定AF与静脉溶栓后临床转归的相关性.结果 共纳入160例接受静脉溶栓治疗的急性缺血性卒中患者,其中67例(41.88％)合并AF.与非AF组相比,AF组年龄更大中位数和四分位数间距:77(71 ～83)岁对69(59 ～78)岁;Z=4.142,P＜0.001],基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NHISS)评分更高11(6～17)分对7(4 ～14)分;Z=2.623,P=0.009].AF组溶栓后24 h3.0(1.0～4.5)分对2.0(0～6.0)分;Z=-0.312,P=0.775]和7 d4.0(2.0～5.0)分对5.0(2.0～8.0)分;Z=1.574,P=0.115]时NIHSS评分较基线降低值以及90 d时转归良好患者比例(38.81％对25.82％;x2 =3.063,P=0.080)与非AF组差异均无统计学意义,但24 h内HT(14.93％对5.38％;x2=4.179,P=0.041)和90 d内死亡(16.42％对6.45％;x2 =4.073,P=0.044)患者比例显著高于非AF组.多变量logistic回归分析显不,AF与90 d时临床转归优势比(odds ratio,OR0.95,95％可信区间(confidence interval,CI)0.381～2.366;P=0.912]、24 h内HT(OR1.992,95％ CI 0.580 ～6.369;P=0.285)以及90 d内死亡(OR 2.483,95％ CI0.727～8.586;P=0.146)均无独立相关性.结论 AF不是影响急性缺血性卒中患者静脉溶栓后90 d时临床转归和24 h内HT的独立危险因素.

Influence of atrial fibrillation on outcome after intravenous thrombolysis for acute ischemic stroke

Objective To investigate the influences of atrial fibrillation (AF) on clinical outcome and hemorrhagic transformation (HT) after intravenous thrombolysis for acute ischemic stroke.Methods The patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator thrombolysis were enrolled retrospectively.The modified Rankin Scale score 0-2 at 90 d was defined as a good outcome.Multivariate logistic regression analysis was used to determine the correlation between AF and clinical outcomes after intravenous thrombolvsis.Results A total of 160 patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator thrombolysis were enrolled,including 67 (41.88％) with AF.Compared with the non-AF group,the age was older (median interquartile range] 77 71-83] years vs.69 59-78] years;Z=4.142,P＜ 0.001),baseline National Institutes of Health Stroke Scale (NHISS) score was higher (11.06.0-17.0] vs.7.04.0-14.0];Z=2.623,P=0.009)in the AF group.There were no significant differences in the NIHSS score reduction and the proportion of patients with good outcomes at 24 h (3.0 1.0-4.5] vs.2.0 0-6.0];Z=-0.312,P=0.775) and7d(4.0 2.0-5.0] vs.5.02.0-8.0];Z=l.574,P=0.115) after thrombolysis and the proportion of patients with good outcome at 90 d (38.81％ vs.25.82％;x2 =3.063,P =0.080) between the AF group and the non-AF group,however,the proportions of HT within 24 h (14.93％ vs.5.38％;x2 =4.179,P =0.041) and death within 90 days (16.42％ vs.6.45％;x2 =4.073,P =0.044) in the AF group were significantly higher than those in the non-AF group.Multivariate logistic regression analysis showed that AF was not independent correlation with the clinical outcomes at 90 d (odds ratio OR] 0.950,95％ confidence interval CI]0.381-2.366;P =0.912),HT within 24 h (OR 1.992,95％ CI0.580-6.369;P =0.285),and death within 90 d (OR 2.483,95％ CI 0.727-8.586;P=0.146).Conclusion AF is not the independent risk factor that influences on clinical outcome at 90 d and-HT within 24 h after intravenous thrombolysis in patients with acute ischemic stroke.