青年卒中患者重组组织型纤溶酶原激活剂静脉溶栓治疗后临床预后不良的危险因素

目的探讨青年卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后临床预后不良的危险因素。方法回顾性、连续性纳入胜利油田中心医院2018年1月至2019年12月收治的首次发病并接受rt-PA静脉溶栓的青年卒中患者114例。根据发病90 d mRS评分,将青年卒中患者分为预后良好组(90 d mRS评分0~2分)和预后不良组(90 d mRS评分3~6分)。比较两组的基本资料并进行多因素回归分析。结果rt-PA静脉溶栓治疗后90 d,84例(73.7%)患者预后良好(预后良好组),30例(26.3%)患者预后不良(预后不良组)。预后不良组合并2型糖尿病、发病后合并意识障碍、溶栓24 h内脑出血、责任大血管闭塞的比例均明显高于预后良好组(均P<0.05);预后不良组入院时NIHSS评分明显高于预后良好组(P<0.05)。预后良好组入院时NIHSS评分明显高于90 d时(P<0.05)。预后良好组90 d mRS与入院时mRS的差值明显低于预后不良组(P<0.05)。多因素Logistic回归分析显示,患者发病后合并意识障碍(OR=0.06,95%CI:0.01~0.40)、责任大血管闭塞(OR=0.14,95%CI:0.03~0.72)是青年卒中rt-PA静脉溶栓治疗后临床预后不良的独立危险因素。结论青年卒中发病后合并意识障碍、责任大血管闭塞是青年卒中rt-PA静脉溶栓治疗后临床预后不良的独立危险因素。

Risk factors of poor clinical prognosis after recombinant tissue-type plasminogen activator intravenous thrombolysis in young stroke patients

Objective To investigate the risk factors of poor prognosis after recombinant tissue-type plasminogen activator(rt-PA)intravenous thrombolysis in the young stroke patients.Methods We retrospectively included consecutive 114 young patients with the first stroke underwent intravenous rt-PA thrombolysis from January 2018 to December 2019 in Shengli Oilfield Central Hospital.Based on their 90 d mRS score,the patients were divided into good prognosis group(90 d mRS score 0-2)and poor prognosis group(90 d mRS score 3-6).Comparison of the baseline characteristics and multiple factor regression models were conducted.Results After 90 d of rt-PA intravenous thrombolysis,84 patients(73.7%)had good prognosis(good prognosis group)and 30 patients(26.3%)had poor prognosis(poor prognosis group).The proportions of type 2 diabetes,post-onset combined consciousness disorder,thrombolysis within 24 h of cerebral hemorrhage,responsible large vessel occlusion in poor prognosis group were all significantly higher than those in good prognosis group(all P<0.05);NIHSS scores on admission in poor prognosis group was significantly higher than that in good prognosis group(P<0.05).NIHSS score in good prognosis group on admission was significantly higher than that on 90 d after thrombolysis(P<0.05).The difference between 90 d mRS and admission mRS in good prognosis group was significantly lower than that in poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that patients with consciousness disorder(OR=0.06,95%CI:0.01-0.40),responsible large vessel occlusion(OR=0.14,95%CI:0.03-0.72)were independent risk factors of poor clinical outcome after rt-PA intravenous thrombolysis in the young patients.Conclusions The consciousness disorder and responsible large vessel occlusion after the onset of stroke in the young patients are independent risk factors for poor clinical prognosis after rt-PA intravenous thrombolysis.